Form Pt-01(A) - Annual Insurance Premium Tax Return - 2002 Page 3
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4Nevada Department of Taxation
SCHEDULE 2
ANNUITY CONSIDERATION WORKSHEET
Account Name:
Company ID:
Tax Year:
PREMIUM TAX OPTION
Qualified Retirement
Total Considerations
Plans
Tax on Considerations
Tax on Annuitization
Annuity Considerations:
(1) Received as Direct Premium
Written:
(2) Received as Annuity Deposit
Funds:
(3) Gross Considerations
(Line 1 plus Line 2):
Deduct:
(4) Returned Considerations:
Surrenders:
(5) Amount Remitted:
(6) Less Amounts in Excess of
Considerations Received:
(7) Deductible Surrenders
(Line 5 less Line 6):
(8) Total Deduction
(Line 4 plus Line 7):
(9) Net Considerations
(Line 3 less Line 8):
Include this amount in
Tax Status of Line (9):
Line 1, Schedule 1,
Non-Taxable by Domicile
Statement of Premium
Tax & Fees on
Retaliatory Basis
Non-Taxable by Nevada
Include in Line 4,
Include in Line 5,
Schedule 1, Statement
Schedule 1, Statement
of Premium Tax & Fees
of Premium Tax & Fees
on Retaliatory Basis
on Retaliatory Basis
PT-02
Revised 12-23-02
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