Form Ipt - Quarterly Insurance Premium Tax Return printable pdf download

Form Ipt - Quarterly Insurance Premium Tax Return

Taxpayer ID #

Federal ID #

________________________

Nevada Department of Taxation

1550 College Parkway, Rm. 115

Department Use Only

Carson City, NV 89706

Amount

Phone: (775) 684-2000

Fax: (775) 684-2020

Check No.

QUARTERLY INSURANCE PREMIUM TAX RETURN

Date Rec'd

Initials

Period Ending

Due Date

Net Quarterly Taxable Premiums/Considerations - Insurance (Do Not Include Industrial Insurance)

Amount of taxable net direct premiums written and net considerations received

this quarter (DO NOT INCLUDE INDUSTRIAL INSURANCE)

Gross premium tax (3.5% or .035 of Line 1) OR Qualified risk retention

Groups (2% or .02 of Line 1)

. Home Office Credit, if qualified (NRS 680B.050) (50% or .5 of

Line 2)

3b.

Amount of Ad Valorem Taxes Paid, if qualified for Home

Office Credit (NRS 680B.050)

3c.

Max credit allowed (See instructions)

3d.

Add lines 3a and 3b. Compare to line 3c. Enter the lesser of the two.

Net premium tax (Line 2 minus Line 3d)

Life/Health Guaranty Association Offset (NRS 686C) to be used on

quarter return only

Property/Casualty Guaranty Association Credit (NRS 687A)

Overpayment From Prior Periods

(

)

Premium tax due (Line 4 minus Lines 5 through 7)

Penalty (See Instructions for rate)

10.

Daily Interest. Premium tax due (Line 8) multiplied by .00049315068 times the

number of days late

11.

Total amount due (Lines 8 plus Lines 9 through 10)

NRS REQUIRES THAT THIS RETURN MUST BE SIGNED

I hereby declare under penalty of perjury that this premium tax return has been examined by me and is a true, correct and complete

report.

Signature of Taxpayer or Authorized

Printed name of Taxpayer or Authorized Agent

Date

Telephone

Agent

Insurance

IPT

10-08-

Form Ipt - Quarterly Insurance Premium Tax Return

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