Form Ip-1 - Insurance Premium Tax Return - 2007
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1
2Vermont Department of Taxes
Taxpayer Services Division
PO Box 547
Montpelier, VT 05601-0547
2007 VERMONT INSURANCE PREMIUM TAX RETURN
Due Date: February 28, 2008
Print or type complete name and address below:
Date Organized:
NAIC #
Under the laws of the State of:
Fed. ID #
Date first licensed to do business in VT:
Computation of Insurance Premium Tax on all business Property and Casualty Companies reported on Schedule T (excluding Accident
& Health) must report under Accident and Health on reverse side.
State of Incorporation
State of Vermont
Basis
Basis
1. Gross direct premiums written on businesses in Vermont during the year.
1.
$
$
2. If a Vermont company, enter the total gross direct premiums outside of
Vermont which are not taxed by another state.
2.
3. TOTAL PREMIUMS (Add Lines 1 & 2)
3.
4. Dividends paid or credited to policyholders
4.
5. Return premiums
5.
6. Other deductions (please specify)
6.
7. TOTAL DEDUCTIONS (Add Lines 4 - 6)
7.
8. TAXABLE PREMIUMS (Subtract Line 7 from Line 3)
8.
9. Tax at rate of _______ % (use 2% for Vermont)
9.
10. Life, Accident and Health and Annuity Tax (from Line 35)
10.
11. TOTAL INSURANCE PREMIUM TAX (Add Lines 9 & 10)
11.
12. LESS: Tax monies paid on estimated returns
12.
13. OVERPAYMENT: If Line 12 is greater than Line 11 enter overpayment
13.
14. Amount of overpayment to be credited to 2008 estimated tax 14.
15. REFUND DUE
15.
16. BALANCE DUE: If Line 11 is greater than Line 12 enter balance due.
Make check payable to: VERMONT DEPARTMENT OF TAXES
16.
SIGNATURE REQUIRED. UNSIGNED RETURNS WILL BE RETURNED.
I hereby certify that this return is true, correct and complete to the best of my knowledge.
Signature of Responsible Officer
Printed Name
Title
Date
Signature of Preparer Other Than Officer
Printed Name
Title
Date
Title/Firm Name
Preparer’s Telephone Number
Date
Form IP-1
(Rev. 1/08)
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