Form Lgt 141 - City, County, Or Urban County Government Quarterly Insurance Premium Tax Return Page 3
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4INSTRUCTIONS FOR FILING
QUARTERLY INSURANCE PREMIUM TAX RETURN (FORM LGT 141)
FOR LOUISVILLE METRO, KENTUCKY
(Pursuant to KRS 91A.080)
1.
This form is to be used as a quarterly tax return to be filed with cities, counties, or urban-county
governments. This form must be filed within thirty (30) days after th e end of the calendar quarter to
which it applies.
2.
Each insurer/broker must file. Group filings are not acceptable. Always give the employer identification
number assigned by the IRS and other required information, including the telephone number of the person
preparing the return and the name and address of the Surplus Lines Broker.
3.
"Premiums collected" (Column 2) means premiums actually received at an insurer's home, administrative, or
regional offices during a calendar quarter. This column is for the reporting of premiums only. D o not
add the amount of taxes collected or paid to the amount reported in this column.
4.
“Tax Payable” (Column 3) is the city/county tax rate times the amount of premium collected. If a city/county
has a minimum tax, you must pay at least that amount quarterly when there is a tax liability.
5.
The “Collection Fee” (Column 4) shall be fifteen percent (15%) of the tax payable or two percent (2%) of the
premium, whichever is less. (The collection fee is an "add-on" and cannot be deducted from the tax
payable.)
6.
Column 5: When the tax payable (the amount in Column 3) is assessed upon the policyholder, Column 5 is
the total of Columns 2 and 3. When the tax and collection fee are assessed upon the policyholder, Column 5
is the total of Columns 2, 3, and 4. If the tax and collections fee are paid solely by the insurer/broker,
Column 5 will equal Column 2.
7.
SPECIAL INSTRUCTIONS RELATED TO SURPLUS LINES BROKERS:
Separate quarterly tax returns shall be submitted to the applicable local government by the surplus lines
broker. Each return submitted to the local governments shall include a listing of the insurance companies
that supplied the coverage for which the premiums and taxes are being reported. This information shall be
listed in the designated section of Form LGT-141. Please note that surplus lines brokers are not required
to submit a separate Form LGT-141 to each municipality for each insuran ce company through w hich
insurance business was exported.
8.
Credits (Form LGT 142) are only used where all of the following are true: the risk is located within the city
limits; the county in which the city is located also imposes a tax; the county issued its ordinance on or after
July 13, 1990; and the county license fee or tax for the applicable category is higher than the city license fee
or tax. Form LGT-142 can be downloaded from our website, , by selecting Forms
and Publications.
9.
Each tax return for each city, county, charter county, consolidated local government, or urban-county
government must bear the certification statement as shown.
10.
Any license fee or tax not paid on or before the due date shall bear interest at the tax interest rate as defined
in KRS 131.010(6) from the date due until paid. Such interest is payable to cities or counties or urban
county governments.
11.
Inquiries regarding the preparation of the tax return should be directed to the Local Government Premium
Tax Unit, Kentucky Office of Insurance, P.O. Box 517, Frankfort, Kentucky 40602.
The tax return on the reverse side is the Quarterly Insurance Premium Tax Return that must be filed for Louisville
Metro, Kentucky. Write "NONE" on the form, if you did not receive any taxable premiums within the jurisdiction. If
you have any questions, please contact the Louisville Metro Revenue Commission at (502) 574-4860. Our office is
located at 617 West Jefferson Street, Louisville, Kentucky 40202.
A street index search file is available on our website, , by clicking on the “Map It” icon located
on our home page. This search file can be used to determine if a risk is located within the Metro Louisville Urban
Service District or the Louisville Metro, Kentucky, jurisdiction. If you have questions or need assistance when using
this site, please call (502) 574-4860.
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