Form Ib-37 - 2007 Additional Local Fire And Lightning Tax Return Property And Casualty Companies
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12007 Additional Local Fire and Lightning Tax
IB-37
I-B
Return Property and Casualty Companies
Web
Insurance
1-08
North Carolina Department of Revenue
Legal Name
Federal Employer ID Number
Mailing Address
City
State
Zip Code
Fill in circle if applicable:
Payment has been made through
Name of Contact Person
Phone Number
State of Domicile
electronic funds transfer (EFT)
(
)
Date of Withdrawal if Company Surrendered Certificate of Authority to do Business in NC During the Year
Schedule A. 2007 Additional Local Fire and Lightning Tax
(A copy of the State Business Page must be attached)
(A)
(B)
(C)
(D)
Direct Premiums
Premiums Outside
Non-Fire Premiums in
Taxable Fire Premiums in
Line of Business
Written
Protected Areas
Protected Areas
Protected Areas
Fire
1.
2.
Farmowners
3.
Homeowners
4.
Commercial Multiple Peril
(non-liability portion)
Ocean Marine
5.
6.
Inland Marine
7.
Private Passenger Auto Physical Damage
8.
Commercial Auto Physical Damage
9.
Aircraft
10.
Boiler and Machinery
11.
Other Fire
12.
Total
$
Additional Local Fire and Lightning Tax Due
13.
Multiply Line 12, Column (D) by 1/2% (0.5%)
In Column (A) enter the direct premiums written as reported on NC State Business Page for each line of business. In Column (B) enter
the direct premiums written in the State that are allocated to areas outside protected fire districts. In Column (C) enter the amount of
direct premiums written in the State that are allocated to protected fire districts and are for contracts that do not provide any fire coverage.
Subtract the amounts in Columns (B) and (C) from Column (A) and enter the result in Column (D).
A reconciliation explaining any difference between Direct Premium Written reported in Column (A) and the NC State Business Page
premiums must be attached.
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
Returns are due by the 15th day of the 3rd month following the end of the calendar year. Your check or money
order must be in the form of U.S. currency from a domestic bank.
N.C. Department of Revenue, Insurance Premium Tax Unit, P.O. Box 25000, Raleigh, NC 27640-0300
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