Form Dexm - Domestic Companies Annual Report - 2008 Page 5
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5DEXM (10-08)
Page 5
IMPORTANT NOTE
PAYMENT for the amount indicated at Schedule A Line 27 of the Insurance Premium Tax Return MUST BE SUBMITTED TO THE
DIVISION OF TAXATION at the address indicated on the first page of this return. DO NOT send payment of this amount to the
Department of Banking and Insurance.
However, if the taxpayer is simultaneously paying an Annual Statement Filing Fee, Renewal of Certificate of Authority Fee,
Maintenance Fee, Insurance Development Fund Surcharge etc., these amounts must be submitted under separate cover to the address
indicated on the notice received for the particular fee, surcharge etc. and MUST NOT be included with the Insurance Premium Tax Return.
**ALL ATTACHMENTS MUST BE INCLUDED WITH BOTH THE ORIGINAL RETURN FILED WITH THE DIVISION OF
TAXATION AND THE DUPLICATE RETURN FILED SIMULTANEOUSLY WITH THE DEPARTMENT OF BANKING AND
INSURANCE.
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