Form Ib-33 - Gross Premium Tax Return Property And Casualty Companies - 2010 Page 3

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Legal Name
FEIN
Page 3, Form IB-33, Web, 1-10
Schedule C. Insurance Regulatory Charge
,
,
,
.
1.
Gross Premium Tax Liability
00
1.
(From Schedule B, Part 1, Total)
,
,
,
.
2.
Additonal Tax on Property Coverage Contracts
2.
00
(From Schedule F, Line 14)
,
,
,
.
3.
Total Premium Tax Liability
00
3.
Add Lines 1 and 2
,
,
,
.
4.
Insurance Regulatory Charge
4.
00
Multiply Line 3 by 5.5%
,
,
,
.
5.
Prior Year Credit Applied to 2009
00
5.
(From Schedule D, Line 1, Column 2)
,
,
,
.
6.
Insurance Regulatory Charge Installment Payments
6.
00
(From Schedule D, Line 5, Column 2)
,
,
,
.
7.
Total Insurance Regulatory Charge Due
$
7.
00
Line 4 minus Line 5 and Line 6, but not less than
,
,
,
.
zero. If less than zero, enter amount on Line 8.
8.
00
8.
Overpayment
,
,
,
.
00
9.
9.
Amount of Line 8 to be Applied to 2010 Insurance Regulatory Charge
,
,
,
.
10. Insurance Regulatory Charge to be Refunded
00
10.
Line 8 minus Line 9
Schedule D. Installment Payments Made
(Do not include amounts from Line 1 on Lines 2 through 4)
(1)
(2)
(3)
Insurance
Additional Property
Gross Premium Tax
Regulatory Charge
Coverage Tax
1.
Prior Year Credit Applied to 2009
(Gross Premium Tax - from 2008 IB-33, Sch. B, Part 3, Line 10)
(Insurance Regulatory Charge - from 2008 IB-33, Sch. C, Line 9)
(Add’l Property Coverage Tax - from 2008 IB-33, Sch. F, Line 19)
2.
Installment Payment made April 15, 2009
(Gross Premium Tax - from 2009 IB-34, Part 1, Line 4)
(Insurance Regulatory Charge - from 2009 IB-34, Part 2, Line 8)
(Add’l Property Coverage Tax - from 2009 IB-34, Part 3, Line 12)
3.
Installment Payment made June 16, 2009
(Gross Premium Tax - from 2009 IB-35, Part 1, Line 4)
(Insurance Regulatory Charge - from 2009 IB-35, Part 2, Line 8)
(Add’l Property Coverage Tax - from 2009 IB-35, Part 3, Line 12)
4.
Installment Payment made October 15, 2009
(Gross Premium Tax - from 2009 IB-36, Part 1, Line 4)
(Insurance Regulatory Charge - from 2009 IB-36, Part 2, Line 8)
(Add’l Property Coverage Tax - from 2009 IB-36, Part 3, Line 12)
5.
Total Installment Payments Made in 2009
Add Lines 2 through 4
Schedule E. Guaranty Association Credit Available
Assessment Amount
Percentage
Amount of Credit
1.
Assessment Year 2004
20%
2.
Assessment Year 2005
20%
3.
Assessment Year 2006
20%
4.
Assessment Year 2007
20%
5.
Assessment Year 2008
20%
Total

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