Insurance Premium Tax Reporting Form 2008

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Municipality
Insurance Premium Tax 2008
:
________________________
Reporting Form
POC: ______________________________________
Tele: ______________________________________
Fax:
______________________________________
Email Address: ______________________________
Fax Date:
NAIC
Insurance Company
Premium
Tax Payment
Check #
Check Date
NOTE: Please fax IPT payment information to (205) 423-4099, or mail to: LaMATS
P.O. Box 830725
Birmingham, AL 35283-0725
Louisiana Municipal Advisory & Technical Services (LaMATS) Bureau

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