Form Ins-4 - Insurance Premiums Tax Return - 2008 Page 2
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3FORM INS-4, Page 2
MAINE REVENUE SERVICES
2008
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INSURANCE PREMIUMS TAX RETURN
*0830001*
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MRS Insurance Premiums Tax Account Number
Part B – Retaliatory Tax Computation
Enter the United States Postal Service two letter state abbreviation for your state of incorporation:
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.00
12. Gross Premiums (Schedule 2, line 1, column H) .......................................................................................... 12.
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.00
13. Allowable Deductions (Schedule 2, line 2, column H) .................................................................................. 13.
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.00
14. Net Taxable Premiums (Schedule 2, line 3, column H) ................................................................................. 14.
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.00
15. Premium Tax on basis of state of incorporation (Schedule 2, line 5, column H) ........................................... 15.
Part C – Tax Due
.00
16. Enter the greater of Part A, line 11 or Part B, line 15 .................................................................................... 16.
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.00
17. Less: Estimated Payments .......................................................................................................................... 17.
.00
18. Tax Credits (Attach schedule – cannot exceed line16) ................................................................................. 18.
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.00
19. Balance Due (If line 16 is greater than the sum of lines 17 and 18, enter the difference) ............................ 19.
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Note:
Certain taxpayers with large annual tax liabilities are required to remit tax payments electronically.
See Maine Rule 102 on the MRS web site (select Laws & Rules) for details.
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20. Overpayment (If the sum of lines 17 and 18 is greater than line 16, enter the difference) ........................... 20.
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.00
21a. Portion of overpayment on line 20 to be APPLIED to next year’s ESTIMATED tax ................................. 21a.
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21b. Portion of overpayment on line 20 to be REFUNDED ............................................................................. 21b.
2009 Quarterly Estimated Tax
The 2009 quarterly tax payments may be on an estimated basis, as long as the April 30 and June 25 installments each equal at least 35% of the total tax liability for
2008 or 35% of the total tax liability for 2009. The October 31 installment must equal 15% of the total tax liability for 2008 or 15% of the total tax liability for 2009.
See Form INS-1 for details. (36 M.R.S.A . § 2521-A).
Affi davit and Signature
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Date __________________________ Signature ____________________________________________ Title _______________________________
Must be signed by the President, Treasurer, Secretary, Chief Accounting Offi cer, or Attorney-in-fact of a Reciprocal Insurer.
Contact Person ______________________________________________________________________ Phone # ____________________________
Preparer’s
Preparer’s
Date __________________________ Signature ____________________________________________ ID Number __________________________
Important Note:
Your return must include required attachments. See page 3 of the instructions for more information.
I prepare my return electronically or my return is prepared by a tax preparer and I do not need Maine tax forms mailed to me next year.
Offi ce
Make check payable to:
Treasurer, State of Maine
use only
Send check and return to:
Maine Revenue Services, P.O. Box 9120, Augusta, ME 04332-9120
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