Form 302 - 2014 Premium Tax Final For Property Companies

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CALENDAR YEAR 2014 PREMIUM TAX FINAL FOR PROPERTY COMPANIES

Office of Superintendent of Insurance, 1120 Paseo De Peralta, Santa Fe, NM 87501, P.O. Box 1689, Santa Fe, NM 87504-1689, Room 433

Make check payable to “Office of Superintendent of Insurance”

For calendar year ending December 31, 2014. Due April 15, 2015.

Late, unsigned and/or incomplete reports will be assessed a penalty pursuant to NMSA 1978, Section 59A-6-4.

Company Name: ___________________________________________________

NM Co. # __________

Company Address: _________________________________________________

Class: ___________

_________________________________________________

NAIC: __________

Contact: _____________________________________________

Phone/Email:

AMENDED,

:_________________________

_____________________________________________

Reason

DEDUCTIONS ALLLOWED:

Supporting Documents Required

1.Gross Premiums

2.Return

3.Dividends

4.Premiums

5.Federally

6. Net Premiums on

received from

premiums or

paid/credited to

received from

Exempt

which the New

policies within

Political

policyholders

Authorized

Premiums

Mexico tax is

CLASS

the State of New

Subdivisions

companies for

based.

Mexico

reinsurance

on NM risks

(1)

Fire

(2.1) Allied Lines Crop- Crop

Hail

(2.2) Federally reinsured allied

Lines

(2.3) Federal Flood

(2) Farm owners Multiple Peril

(4) Homeowners Multiple Peril

(5.1) Commercial Multiple Peril

(non-liability)

(5.2) Commercial Multiple Peril

(liability)

(8) Ocean Marine

(9) Inland Marine

(12) Earthquake

Miscellaneous

1. TOTALS

2. Premium Tax Due (3.003% of line 34 Column )

3. Less 1

and 2

quarterly taxes paid (include credit taken)

4. Less 3

and 4

quarterly taxes paid (include credit taken)

5. Less year 2013 remaining credit not used in line 3 & 4

#78

7.Net Premium Taxes Due

Total Amount of Check

Check #

The signature for the Authorized Preparer means that: 1) The Authorized Preparer is authorized by the company’s Board of Directors to prepare this report. 2)

The Authorized Preparer has examined this report. 3) The contents of this report are true and correct to the best of the Authorized Preparer’s knowledge.

NOTARY SEAL

_____________________________

President/Authorized Signature

Notary Signature ________________________

My Commission Expires __________________

_____________________________

Subscribed and sworn before me this ________ day of __________, 20___

Secretary/Treasurer/Authorized Signature

Postmarked _______

Initials

_________

Form 302