Form Ins-6 - Maine Estimated Quarterly Return For Surplus Lines Premium Tax

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FORM INS-6
MAINE ESTIMATED QUARTERLY RETURN FOR
SURPLUS LINES PREMIUM TAX
00
Due 05/02/05
1st Quarter 2005, 01/01/05 - 03/31/05
*0532001*
.
Instructions and worksheet are on the other side of this return
-
-
Producer ___________________________________________
0 1
Producer’s SSN .............................
Address ___________________________________________
Estimated Payment
___________________________________________
$
,
,
(see instructions on back) ..................
.00
Signature ___________________________________________
Must be signed by the producer with surplus lines authority.
REMITTANCE MUST ACCOMPANY RETURN
Telephone ___________________________________________
Make check payable to :
Treasurer, State of Maine
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
Company ___________________________________________
Augusta, ME 04332-9120
FORM INS-6
MAINE ESTIMATED QUARTERLY RETURN FOR
SURPLUS LINES PREMIUM TAX
00
Due 06/27/05
2nd Quarter 2005, 04/01/05 - 06/30/05
*0532001*
.
Instructions and worksheet are on the other side of this return
-
-
Producer ___________________________________________
01
Producer’s SSN .............................
Address ___________________________________________
Estimated Payment
___________________________________________
$
,
,
(see instructions on back) ..................
.00
Signature ___________________________________________
Must be signed by the producer with surplus lines authority.
REMITTANCE MUST ACCOMPANY RETURN
Telephone ___________________________________________
Make check payable to :
Treasurer, State of Maine
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
Company ___________________________________________
Augusta, ME 04332-9120
FORM INS-6
MAINE ESTIMATED QUARTERLY RETURN FOR
SURPLUS LINES PREMIUM TAX
00
Due 10/31/05
3rd Quarter 2005, 07/01/05 - 09/30/05
*0532001*
.
Instructions and worksheet are on the other side of this return
-
-
Producer ___________________________________________
01
Producer’s SSN .............................
Address ___________________________________________
Estimated Payment
___________________________________________
$
,
,
(see instructions on back) ..................
.00
Signature ___________________________________________
Must be signed by the producer with surplus lines authority.
REMITTANCE MUST ACCOMPANY RETURN
Telephone ___________________________________________
Make check payable to :
Treasurer, State of Maine
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
Company ___________________________________________
Augusta, ME 04332-9120

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