Form Iip-R - Annual Industrial Insurance (Workers Compensation) Reconciliation Premium Tax Return - 2008 Page 4

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were originally required to be paid or within 30 days after the date of payment of any additional tax, charge or fee. If you owe
premium tax and/or retaliatory assessment, make check payable to the Department of Taxation.
IIP-R
Revised 2-2-09

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