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Line 7 Gross Industrial Insurance Premium Tax Enter the amount of Gross Premium Tax. Multiply Line 6 by 3.5% or .035.

Line 8 Industrial Insurance Credit Enter the amount paid to Division of Industrial Relations for the year. Each insurer providing

industrial insurance in this state is entitled to a credit against the premium tax paid equal to the assessment paid to Division of

Industrial Relations. (NRS 680B.036). This credit is to be applied only against the premium tax for the year in which the assessment

to the Division of Industrial Relations was paid. The Credit can not be applied against future premium tax liability.

Line 9. Subtotal Enter in premium tax due. Line 7 minus Line 8.

Line 10a Home Office Credit. 50% or .5 of Line 4. NRS 680B.050 provides that insurers who maintain a “home” or “regional” office

may be entitled to a credit against tax to be paid. It provides for a 50 percent credit for taxes due. Each insurer claiming a home or

regional home office credit must have a certified copy of the deed to the property in the name of the insurer on file with the

Department.

Line 10b Ad Valorem Taxes Enter the amount of ad valorem Taxes paid during this year. NRS 680B.050(1) provides for credit for

ad valorem taxes actually paid upon the home office or regional home office together with the land, as reasonably required for the

convenient use of the office, upon which the home office or regional home office is situated. Further, the insurer must provide

certified copies of the billing by local authorities for the ad valorem taxes in addition to a receipt for proof of payment.

Line 10c Max Credit allowed Enter max credit allowed. Multiply Line 7 by 80% or .80. NRS 680B.050(1) imposes a limit on the

total amount of the credit that may be obtained. The credits may not reduce the total amount of taxes payable to less than 20 percent

of the amount of gross premium taxes payable.

Line 10d Enter the available Home Office Credit and Ad Valorem taxes credit. Add lines 10a and 10b. Compare to line 10c. Enter

the lesser of the two.

Line 11 Enter the amount of Property/Casualty Guaranty Association credit to be used this year.

Line 12 Enter the amount of cash payments made on the Industrial Insurance quarterly premium tax returns.

Line 13 Enter the amount due to you for overpayments made in prior reporting periods for which you have received a Department of

Taxation Credit Notice. Monthly notices received from the Department are not cumulative. Do not take the credit if you have applied

for a refund. NOTE: Only credits established by the Department may be used.

Line 14 Enter the amount of Overpayments refunded by Nevada during the calendar year.

Line 15 Net Premium Tax Due. Enter the amount of Net Premium Tax due. Line 9 minus Lines 10d through 13 plus Line 14.

Line 16 Penalty If this return is not submitted/postmarked and taxes are not paid on or before the due date as shown on the face of

this return, the amount of penalty due is a) For returns with Period(s) Ending prior to and including 3/31/07 the Penalty is 10%; b) For

returns with Period(s) ending 4/30/07 and after; the amount of penalty due is based on the number of days the payment is late per

NAC 360.395 (see table below). The maximum penalty is 10%.

Number of days late

Penalty Percentage

Multiply by:

1 - 10

0.02

11 - 15

0.04

16 - 20

0.06

21- 30

0.08

31 +

10%

0.10

Determine the number of days late the payment is, and multiply the net tax owed (Line 15) by the appropriate rate based on the table

above. The result is the amount of penalty that should be entered. For Example, the taxes were due January 31, but not paid until

February 15 so the penalty is 4%.

Line 17 Daily Interest If this return will not be postmarked and the taxes paid on or before the due date as shown on the face of this

return, interest will be calculated daily. Line 15 multiplied by .00049315068 times the number of days late.

Line 18 Total Adjusted Premium Tax Due If the calculated amount entered on this line results in a negative figure, this amount is the

premium tax overpayment that will be credited to your account or refunded. Enter the amount to be carried forward or refunded in the

appropriate box. Pursuant to NRS 680B.120 request for refund must be made within 1 year after the date such fees, charges or taxes

IIP-R

Revised 2-2-09

Form Iip-R - Annual Industrial Insurance (Workers Compensation) Reconciliation Premium Tax Return - 2008 Page 3

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