Form Lgt 142 - City Credit Against County Taxes 2004

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Commonwealth of Kentucky
Name Of County:
For The Period Date:
Office of Insurance
For The Year Date:
CITY CREDIT AGAINST COUNTY TAXES
)
(Attach to LGT 141 and LGT 140
CREDITS
PREMIUM/
FIRE AND
INLAND
MOTOR
ALL OTHER
(NAME OF CITY)
TAX
RATE
CASUALTY
ALLIED
HEALTH
MARINE
LIFE
VEHICLE
RISKS
TOTALS
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
PREMIUM
TAX
(Premium)
GRAND
TOTALS
(Tax)
Form LGT 142 (04/04)

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