Form Pt-03 - Quarterly Insuarance Premium Tax Return - 2005

ADVERTISEMENT

Company ID (New):
Nevada Department of Taxation
1550 E College Parkway, Rm. 115
Department Use Only
Carson City, NV 89706
Amount
Phone: (775) 684-2000
Fax: (775) 684-2020
Check No.
Date Rec'd
QUARTERLY INSURANCE PREMIUM
Initials
2005
TAX RETURN
Period Ending
Due Date
Net Quarterly Taxable Premiums/Considerations - Insurance (Do Not Include Industrial Insurance)
1. Amount of taxable net direct premiums written and net considerations
received this quarter (DO NOT INCLUDE INDUSTRIAL INSURANCE)
2. Gross premium tax (3.5% or .035 of Line 1)
3a. Home office credit, if qualified (NRS 680B.050) (50% or .5 of Line 2)
(
)
3b. Risk Retention group credit, if qualified (42.85% or .4285 of Line 2)
(
)
4. Net premium tax (Line 2 minus Lines 3a and 3b)
5. Property/Casualty Guaranty Association Credit (NRS 687A)
6. Overpayment From Prior Periods.
(
)
7. Premium tax due (Line 4 minus Lines 5 through 6)
8. Penalty 10% or .10 of Line 7 (If postmarked after due date)
9. Interest 1.5% or .015 of Line 7 (If postmarked after due date, for each
month or fraction of a month past due)
10. Total amount due (Lines 7 plus Lines 8 through 9)
NRS REQUIRES THAT THIS RETURN MUST BE SIGNED
I hereby declare under penalty of perjury that this premium tax return has been examined by me and is a true, correct and complete report.
Signature of Taxpayer or Authorized Agent Printed name of Taxpayer or Authorized Agent
Date
Telephone
DEPARTMENT USE ONLY
Insurance
PT-03
Revised 9/21/2005

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Pt-1 - Vermont Propertty Transfer Tax Return - 2005 Form Pt-1 - Vermont Propertty Transfer Tax Return - 2005 Financial
Form Pt-01 - Annual Insurance Premium Tax Return - 2004 Form Pt-01 - Annual Insurance Premium Tax Return - 2004 Financial
Form Pt-200 - Quarterly Petroleum Business Tax Return Form Pt-200 - Quarterly Petroleum Business Tax Return Financial
Form Tc-40 - Utah Individual Income Tax Return - 2005 Form Tc-40 - Utah Individual Income Tax Return - 2005 Financial
Form Ia 1040c - Composite Individual Income Tax Return - 2005 Form Ia 1040c - Composite Individual Income Tax Return - 2005 Financial
Form Ct-1120x Amended Corporation Business Tax Return - 2005 Form Ct-1120x Amended Corporation Business Tax Return - 2005 Financial
Form 807 - Michigan Composite Individual Income Tax Return - 2005 Form 807 - Michigan Composite Individual Income Tax Return - 2005 Financial
Form 104x - Amended Colorado Individual Income Tax Return - 2005 Form 104x - Amended Colorado Individual Income Tax Return - 2005 Financial
Form 540 2ez - California Resident Income Tax Return - 2005 Form 540 2ez - California Resident Income Tax Return - 2005 Financial
Form 540 C1 California Resident Income Tax Return 2005 Form 540 C1 California Resident Income Tax Return 2005 Financial

Related Categories

Parent category: Financial
Download
Go