Form Ins 4 - Insurance Premium Tax Annual/reconciliation Return - 2002
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2*023000000*
FORM INS-4
INSURANCE PREMIUM TAX
ANNUAL/RECONCILIATION RETURN
023000000
Entity Information:
Check here if you made estimate
payments during the year
Check here if this is a Risk
Retention Group
This return is made in compliance with the provisions of 36 M.R.S.A. §§ 2521-A and 2513-A. The amount of all GROSS DIRECT PREMIUMS or insurance written by this
company on risks located in, or received from risks resident of, the State of Maine during the above period was as follows:
Part A – Maine Tax Computation
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Please submit a copy of Schedule T (Exhibit of Premiums Written)
and page 24 (or Maine portion) of the NAIC Annual Statement.
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