Insurance Premium And Surplus Lines Premium Tax - Elective Statement printable pdf download

Insurance Premium And Surplus Lines Premium Tax - Elective Statement

STATE OF MAINE

MAINE REVENUE SERVICES

INCOME/ESTATE TAX DIVISION

INSURANCE PREMIUM AND SURPLUS LINES PREMIUM TAX

ELECTIVE STATEMENT

Title 36, MRSA Section 2521-A provides that Insurance Premium and Surplus Lines

Premium Tax returns may be filed on an estimated basis, provided that each April and

June installment equals at least 35% of the total tax paid for the preceding calendar year

or 35% of the total tax to be paid for the current calendar year. The remaining

installment must equal 15% of the total tax to be paid for the preceding calendar year or

15% of the total tax to be paid for the current year.

The section further provides that an authorized company official shall affirm which

elective is selected and that such elective cannot be changed during the current calendar

year.

Unless this completed elective statement is returned, it will be presumed that your

Insurance Company has elected to file quarterly installments equal to at least 35% and

15% of the preceding calendar year's tax. Should this not be the case, please complete

this statement and check the box below.

[ ]

Quarterly installments will be at least 35% and 15% of current calendar year tax.

ACCOUNT ID #______________________________________TAX YEAR________________

COMPANY NAME: ____________________________________________________________

ADDRESS:

______________________________________________________________________________

TELEPHONE #: _______________________________________________________________

Signed: ___________________________________

Title: ____________________________________

Must be authorized company official

(President, Treasurer, Secretary or

Attorney-in-fact)

Date: ____________________________________

Insurance Premium And Surplus Lines Premium Tax - Elective Statement