Form 20-Ins - Oregon Insurance Excise Tax Return - 2002 Page 2
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420. Income before net loss deduction—carried forward from page 1, line 19 .................................................... 20
If income is derived from sources both in Oregon and other states, carry amount on line 20 to
Schedule AP-2, line 1, and skip line 21 below. Please complete both Schedule AP-1 and Schedule AP-2.
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21. Net loss deduction. Attach schedule (see instructions) .............................................................................. 21
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22. Oregon taxable income (line 20 minus line 21 or amount from Schedule AP-2, line 9) ................................ 22
23.
Excise tax (6.6 percent of line 22) ($10 minimum tax)
................................................................................ 23
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24. Tax adjustment for interest on certain installment sales ............................................................................... 24
25. Total tax (line 23 plus line 24) ....................................................................................................................... 25
CREDITS
[see circular Tax Credits for Corporations (150-102-694)]
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26. Other credits ___________________________________________________ ....... 26
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27. Workers’ Compensation credit ................................................................................... 27
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28. Fire insurance gross premiums tax credit .................................................................. 28
29. Total (add lines 26 through 28) ..................................................................................................................... 29
30. Line 25 minus line 29 (not less than $10) ..................................................................................................... 30
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31. OLHIGA (Oregon Life and Health Insurance Guaranty Association) offset .................. 31
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32. OIGA (Oregon Insurance Guaranty Association) offset ............................................. 32
33. Total (line 31 plus line 32) ............................................................................................................................. 33
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34. Net excise tax* (line 30 minus line 33) (not less than $10) ........................................................................... 34
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35. Estimated tax payments
for tax year 2002
... 35
(from Schedule ES below). Include payments made with your extension
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36.
Tax Due.
Is line 34 more than line 35? If so, line 34 minus line 35 .............................................
Tax Due
36
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37.
Overpayment.
Is line 34 less than line 35? If so, line 35 minus line 34 .............................
Overpayment
37
38. Penalty due with this return (see instructions) ........................................................... 38
39. Interest due with this return (see instructions) ........................................................... 39
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40. Interest on underpayment of estimated tax. Attach Form 37 (see instructions) ......... 40
41. Total penalty and interest (add lines 38 through 40) ..................................................................................... 41
42.
Total due
(line 36 plus line 41) ..................................................................................................
Total Due
42
43.
Refund
available (line 37 minus line 41) ......................................................................................
Refund
43
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44. Amount of refund to be credited to 2003 estimated tax .........................................................
2003 Credit
44
45.
Net Refund
(line 43 minus line 44) .......................................................................................
Net Refund
45
*If the amount on line 34 above is $500 or more, see the instructions for interest on underpayment of estimated tax.
SCHEDULE ES — ESTIMATED TAX PAYMENTS OR OTHER PREPAYMENTS
(see instructions)
Date of Payment
Voucher
Month
Day
Year
Amount Paid
1. Voucher 1
1
1
2. Voucher 2
2
2
3. Voucher 3
3
3
4. Voucher 4
4
4
5. Overpayment of last year’s tax elected as a credit against this year’s tax ................................................ 5
6. Payments made with extension or other prepayments for this tax year (date paid _____/_____/_____) ... 6
7. Total prepayments (carry to line 35 above) ................................................................................................ 7
8. Last year’s net excise tax from 2001 Form 20-INS, line 34 ........................... 8
Under penalties of false swearing, I declare that I have examined this return, including accompanying schedules and statements, and
to the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than taxpayer, this declaration
is based on all information of which the preparer has any knowledge.
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SIGN
Signature of officer
Date
Signature of preparer other than taxpayer
HERE
Title
Address
FILE THIS RETURN WITH THE OREGON DEPARTMENT OF REVENUE
Mail refund returns and no tax due returns to:
Mail tax-to-pay returns to:
Refund, PO Box 14777, Salem OR 97309-0960
Oregon Department of Revenue, PO Box 14790, Salem OR 97309-0470
150-102-129 (Rev. 1-03)
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