Form Ip-1 - Insurance Premium Tax Return - 2006
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1
2Form IP-1
2006 VERMONT INSURANCE PREMIUM TAX RETURN
MAIL REPORT WITH TAX PAYMENTS TO:
VERMONT DEPARTMENT OF TAXES
TAXPAYER SERVICES DIVISION
133 STATE STREET
MONTPELIER, VT 05633-1401
Return Due Date: February 28, 2007
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
State of Incorporation
State of Vermont
reported in SCH.T - excluding A & H (must report A & H on reverse).
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
Vermont that 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 _______ % (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 paid on estimated returns
12.
13. OVERPAYMENT: If Line 12 is larger than Line 11 enter overpayment
13.
14. Amount of overpayment to be credited to 2007 estimated tax: 14.
15. REFUND DUE:
15.
16. BALANCE DUE: If Line 11 is larger than Line 12 enter amount due.
Make your check payable to: VERMONT DEPARTMENT OF TAXES
16.
UNSIGNED RETURNS WILL BE RETURNED.
I hereby certify 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/Firm Name
Preparer’s Telephone Number
Date
Form IP-1
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