Form Fmaa - Annual Report Of Premiums And Taxes Of All Fermers Mutual Aid Associations - 2011 Page 3

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ARKANSAS INSURANCE DEPARTMENT
2011 FORM AID AC FMAA-T
ACCOUNTING DIVISION
ACCOUNTING DIVISION
DUE MARCH 1, 2012
1200 WEST THIRD STREET
______ ORIGINAL FILING
LITTLE ROCK, AR 72201-1904
PHONE: (501) 371-2605
______ AMENDED FILING
ANNUAL REPORT OF PREMIUMS AND TAXES
______REFUND DUE
OF ALL FARMERS MUTUAL AID ASSOCIATIONS
STATE OF DOMICILE
NAIC COMPANY CODE
(5 digit code)
COMPANY NAME
MAILING ADDRESS
CONTACT PERSON
TITLE
TELEPHONE NUMBER
EXT
FAX NUMBER
EMAIL ADDRESS
Pursuant to ACA 23-73-105(f)(1) and (3), net direct premiums written on policies containing burglary and theft, glass, leakage and fire
extinguisher equipment, livestock, miscellaneous coverage, and liability coverages, written as a supplement to a fire insurance policy or
package commonly referred to as a homeowner or farmowner policy, are subject to premium tax provisions of ACA 26-57-601, et seq.
0.00
1.
Direct Net Written Premiums
$______________________
0.00
2.
Tax Thereon at 2-1/2%
$______________________
0.00
3.
Less Affordable Neighborhood Housing Credit
$(_____________________)
0.00
4.
Less Low-Income Housing Tax Credit
$(_____________________)
0.00
5.
Less AR Historic Rehab Income Tax Credit
$(_____________________)
0.00
6.
Less Delta Geotourism Incentive Tax Credit
$(_____________________)
0.00
7.
Subtotal of Taxes Due
$___________________
0.00
8.
Less Capital Development Corporation Tax Credit
$(_____________________)
0.00
9.
Less Coal Mining Enterprise Credit
$(_____________________)
0.00
10. Less Equity Investment Incentive Tax Credit
$(_____________________)
0.00
11. TOTAL TAXES DUE
$______________________
0.00
12. Less 2011 prepayments (from below)
$(_____________________)
0.00
13. NET PAYMENT DUE
$___________________
2011 FORM AID AC EST-Q PREPAYMENTS
First Quarter
check #
$
0
0.00
Second Quarter check #
$
0
0.00
Third Quarter
check #
$
0
0.00
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