Form Ins-1 - Maine Estimated Quarterly Return For Premium And/or Workers Compensation Insurance Tax

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FORM INS-1
MAINE ESTIMATED QUARTERLY RETURN FOR
PREMIUM AND/OR WORKERS COMPENSATION INSURANCE TAX
00
Due 05/02/05
1st Quarter 2005, 01/01/05 - 03/31/05
*0530001*
Instructions and worksheet are on the other side of this return.
Insurance Account Number
Company ___________________________________________
You are not required to file estimated quarterly returns if:
Address ___________________________________________
1. you are a Risk Retention Group and file only an annual Insurance Premium
Tax Return, Form INS-4, or
___________________________________________
2. your annual tax obligation does not exceed $500 and you obtain approval
from the State Tax Assessor to file only an annual return.
*
Signature ___________________________________________
Estimated Payment
$
,
,
(see instructions) ................................
.00
Name/Title ___________________________________________
PAYMENT MUST ACCOMPANY RETURN
Make check payable to :
Treasurer, State of Maine
Telephone ___________________________________________
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
*Must be signed by the President, Treasurer, Secretary, Chief
Augusta, ME 04332-9120
Accounting Officer, or Attorney-in-Fact of a Reciprocal Insurer.
FORM INS-1
MAINE ESTIMATED QUARTERLY RETURN FOR
PREMIUM AND/OR WORKERS COMPENSATION INSURANCE TAX
00
Due 06/27/05
2nd Quarter 2005, 04/01/05 - 06/30/05
*0530001*
Instructions and worksheet are on the other side of this return.
Insurance Account Number
Company ___________________________________________
You are not required to file estimated quarterly returns if:
Address ___________________________________________
1. you are a Risk Retention Group and file only an annual Insurance Premium
Tax Return, Form INS-4, or
___________________________________________
2. your annual tax obligation does not exceed $500 and you obtain approval
from the State Tax Assessor to file only an annual return.
*
Signature ___________________________________________
Estimated Payment
$
,
,
(see instructions) ................................
.00
Name/Title ___________________________________________
PAYMENT MUST ACCOMPANY RETURN
Make check payable to :
Treasurer, State of Maine
Telephone ___________________________________________
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
*Must be signed by the President, Treasurer, Secretary, Chief
Augusta, ME 04332-9120
Accounting Officer, or Attorney-in-Fact of a Reciprocal Insurer.
FORM INS-1
MAINE ESTIMATED QUARTERLY RETURN FOR
PREMIUM AND/OR WORKERS COMPENSATION INSURANCE TAX
00
Due 10/31/05
3rd Quarter 2005, 07/01/05 - 09/30/05
*0530001*
Instructions and worksheet are on the other side of this return.
Company ___________________________________________
Insurance Account Number
You are not required to file estimated quarterly returns if:
Address ___________________________________________
1. you are a Risk Retention Group and file only an annual Insurance Premium
Tax Return, Form INS-4, or
___________________________________________
2. your annual tax obligation does not exceed $500 and you obtain approval
from the State Tax Assessor to file only an annual return.
*
Signature ___________________________________________
Estimated Payment
$
,
,
(see instructions) ................................
.00
Name/Title ___________________________________________
PAYMENT MUST ACCOMPANY RETURN
Make check payable to :
Treasurer, State of Maine
Telephone ___________________________________________
Send return with check to:
Maine Revenue Services, P.O.Box 9120,
*Must be signed by the President, Treasurer, Secretary, Chief
Augusta, ME 04332-9120
Accounting Officer, or Attorney-in-Fact of a Reciprocal Insurer.

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