Form E-Rg - Foreign Risk Retention Group Annual Tax Report Page 6

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COMPANY NAME:
State Of Incorporation:
NAIC#:
YEAR:
LOCAL/REGIONAL TAX (for Retaliatory Taxes and Fees Worksheet)
All insurers domiciled in a State listed below must compute Local or Regional taxes using the rates
published below. Arizona Administrative Code R20-6-205
Additions to the rate of tax
State of Domicile
for Other Foreign or Alien
Insurers
1.
Alabama
0.477920%
2.
Florida
0.063183%
3.
Georgia
2.496938%
4.
Illinois
0.000000%
5.
Kentucky
6.031165%
6.
Louisiana
0.773154%
7.
Missouri
0.000000%
8.
Nebraska
0.000000%
9.
New York
0.391642%
10.
Pennsylvania
0.000000%
11.
South Carolina
2.034034%
12.
West Virginia
0.007332%
0.00
A Taxable premiums from Page 2, line 4
$
B Enter Line# _____ and rate for your state of domicile from above
%
0.00
C Local/Retaliatory Tax (Page 7, line 22)
$
E-RG (11/09)
Arizona Department of Insurance
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