Form 1366 - Insurance Company Annual Return For Sbt And Retaliatory Tax - 2001 Page 2
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1
2Foreign and alien insurers complete lines 31 - 47. Domestic insurers go to line 47.
31.
Enter the amount from line 30
31
00
Column A
Column B
State of Incorporation
Michigan
TAXES
32.
State of incorporation tax
32.
33.
Michigan single business tax from line 31
33.
FEES AND ASSESSMENTS
25.00
34.
Annual statement filing fee
34.
35.
Certificate of Authority renewal fee
35.
36.
Certificate of Compliance
36.
37.
Certificate of Deposit
37.
38.
Certificate of Valuation
38.
39.
Enter the total of other fees paid in your state of
incorporation. Attach a detailed schedule of fees
39.
40.
Fire Marshall Tax
40.
41.
Second Injury Fund
41.
42.
Silicosis & Dust Disease Fund
42.
43.
Safety Education and Training Fund
43.
44.
Enter the total of all other assessments. Attach
a detailed schedule of assessments
44.
TOTAL
4
4
45.
Total taxes and assessments. Add lines 32 - 44.
45.
4
46.
Retaliatory amount. Subtract line 45 col. B from col. A; not less than 0
00
46
Amount due. Add lines 31 and 46. Domestic insurers enter the amount from line 30
4
00
47.
47
PAYMENTS, REFUNDABLE CREDITS AND TAX DUE
48.
Credit forward from 12/31/2000 SBT return, line 60
00
48
49.
Estimated tax payments
00
49
50.
Tax paid with request for extension
00
50
51.
Refundable Credits from C-8000MC, line 10
00
51
4
52.
Total Payments. Add lines 48 through 51
00
52
a.
Add to line 52 any payment of tax made with your original return
OR
53.
Complete this line
b.
Subtract from line 52 any refund of tax you received with your original return
only if you are
amending a return.
c.
Net payments
4
00
53
Amended filers use line 53 instead of line 52 for all references below.
4
54.
TAX DUE. Subtract line 52 from line 47. If less than zero, leave blank
00
54
55.
Underpaid estimate penalty and interest. See instructions.
00
55
56.
Annual return penalty at ___ % = _________.00 and interest at ___% = _________.00
00
56
57.
PAYMENT DUE. Add lines 54 - 56. Enter this amount here and on page 1, line 61
00
57
OVERPAYMENT - REFUND OR CREDIT FORWARD
58.
OVERPAYMENT. If line 52 is more than line 47, subtract line 47 from line 52
00
58
4
59.
How much of the amount on line 58 do you want refunded to you?
00
59
4
60
How much of the amount on line 58 do you want credited forward?
00
60
This return must be filed by March 1, 2002.
SIGNATURE AND PREPARER AUTHORIZATION
TAXPAYER'S DECLARATION
PREPARER'S DECLARATION
I declare under penalty of perjury that this return is true
I declare under penalty of perjury that this return is based on all
and correct to the best of my knowledge.
information of which I have any knowledge.
I authorize Treasury to discuss my return with my preparer.
Preparer's Signature
Date
Yes
No
Taxpayer's Signature
Date
Business Address and Phone
Title
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