Form Sch-Rt - Retaliatory Taxes And Fees Worksheet Page 2
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1
2RETALIATORY TAXES AND FEES WORKSHEET (continued)
COMPANY NAME:
State Of Incorporation:
NAIC#:
YEAR:
DO NOT COMPLETE AND FILE THIS PAGE IF YOU ARE NOT DOMICILED IN A STATE
LISTED BELOW
LOCAL/REGIONALTAX - Page 1, Column B, Line 30
All insurers domiciled in a State listed below must compute Local or Regional taxes pursuant to Arizona
Administrative Code R20-6-205, using the rates published below.
STATE OF
FOREIGN OR ALIEN
LIFE
OTHER
FOREIGN or
DOMICLE
INSURER
ALIEN INSURER
Column A
Column B
1.
ALABAMA
0.144985%
0.128048%
2.
FLORIDA
0.039349%
0.032516%
3.
GEORGIA
1.055592%
2.371295%
4.
ILLINOIS
0.000000%
0.000464%
5.
KENTUCKY
0.192252%
0.105480%
6.
LOUISIANA
0.674724%
0.669664%
7.
MISSOURI
0.000000%
0.000000%
8.
NEBRASKA
0.000000%
0.000000%
9.
NEW YORK
0.258337%
0.154301%
10.
PENNSYLVANIA
0.000000%
0.000000%
11.
SOUTH CAROLINA
0.906785%
0.940652%
12.
WEST VIRGINIA
0.014767%
0.020500%
INSURERS
AUTHORIZED TO ISSUE LIFE INSURANCE POLICIES OR ANNUITIES IN
ARIZONA:
0.00
A. Enter amount from Page 1, Part 1, Column A, Line 9.
$
B. Enter Rate from chart above,
Column
A, Line _____ (insert line #)
%
C. Multiply Line A times Line B and enter result.
0.00
$
Carry this amount to Page 1, Column B, Line 30.
OTHER INSURERS
NOT AUTHORIZED TO ISSUE LIFE INSURANCE POLICIES OR ANNUITIES
IN ARIZONA:
0.00
D. Enter amount from Page 1, Part 1, Column A, Line 9.
$
E. Enter Rate from chart above,
Column
B, Line _____ (insert line #)
%
F. Multiply Line D times Line E and enter result.
0.00
Carry this amount to Page 1, Column B, Line 30.
$
Sch-RT (Rev. 12/08)
ARIZONA DEPARTMENT OF INSURANCE
PAGE 2 OF 2
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