Form Ins-5 - Fire Investigation And Prevention Tax

Form Ins-5 - Fire Investigation And Prevention Tax - 2002 Page 2

*023110100*

Form INS-5, Page 2

.00

DATE _____________________________________________

*BY _____________________________________________

CONTACT PERSON _________________________________

TITLE ___________________________________________

TELEPHONE NUMBER ______________________________

*Must be signed by the President, Treasurer, Secretary, Chief Accounting Officer, or Attorney-in-fact of a Reciprocal Insurer.

INSTRUCTIONS

Column 1 must agree with column 1 of the Maine portion of your NAIC annual statement. Percentages for column 4 are taken from the

enclosed notice.

Line 3b – Special Assessment. This amount is .004 for January through June and .006 for July through December.

The State Tax Assessor annually establishes the interest rate by rule. The interest rate for calendar year 2003 is 0.5833% per month, com-

pounded monthly.

The penalty for failure to file a return is the greater of $25 or 10% of the tax due. If the return is not filed within 30 days after the receipt of a

demand notice to file, the penalty is 100% of the tax due.

The penalty for failure to pay a tax liability on time is 1%, up to a maximum of 25%, of the

outstanding liability.

Office use only

Form Ins-5 - Fire Investigation And Prevention Tax - 2002 Page 2

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