Form 1076 - Annual Municipal Premium & Tax Report - Louisiana Department Of Insurance - 2011 Page 4

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NAIC NUMBER:
COMPANY NAME:
MUNICIPAL TAX
MUNICIPAL TAX
CODE
MUNICIPALITY OR PARISH
DIRECT PREMIUMS
LIABILITY
CODE
MUNICIPALITY OR PARISH
DIRECT PREMIUMS
LIABILITY
1454
Quitman
1671
St. Mary Parish
1455
Rapides Parish
1672
St. Tammany Parish
1460
Rayne
1675
Sterlington
1470
Rayville
1677
Stonewall
1475
Red River Parish
1680
Sulphur
1477
Reeves
1690
Sun
1480
Richland Parish
1700
Sunset
1483
Richmond
1710
Tallulah
1484
Richwood
1720
Tangipahoa
1485
Ridgecrest
1725
Tangipahoa Parish
1490
Ringgold
1727
Tensas Parish
1493
Robeline
1728
Terrebonne Parish
1495
Rodessa
1730
Thibodaux
1500
Rosedale
1731
Tickfaw
1510
Roseland
1732
Tullos
1520
Rosepine
1733
Turkey Creek
1530
Ruston
1734
Union Parish
1535
Sabine Parish
1735
Urania
1536
Saline
1736
Varnado
1540
Sarepta
1737
Vernon Parish
1545
Scott
1738
Vidalia
1547
Shongaloo
1739
Vermilion Parish
1550
Shreveport
1740
Ville Platte
1560
Sibley
1750
Vinton
1565
Sicily Island
1760
Vivian
1567
Sikes
1770
Walker
1569
Simpson
1771
Washington
1570
Simmesport
1775
Washington Parish
1571
Simsboro
1780
Waterproof
1572
Slaughter
1790
Webster Parish
1580
Slidell
1800
Welsh
1590
Sorrento
1805
W. Baton Rouge Parish
1595
South Mansfield
1807
W. Carroll Parish
1598
Spearsville
1809
W. Feliciana Parish
1600
Springfield
1810
Westlake
1610
Springhill
1820
West Monroe
1620
St. Bernard Parish
1830
Westwego
1630
St. Charles Parish
1840
White Castle
1640
St. Francisville
1845
Wilson
1645
St. Gabriel
1848
Winn Parish
1650
St. Helena Parish
1850
Winnfield
1655
St. James Parish
1860
Winnsboro
1657
St. John the Baptist Par.
1865
Wisner
1660
St. Joseph
1867
Woodworth
1664
St. Landry Parish
1870
Youngsville
1667
St. Martin Parish
1875
Zachary
1670
St. Martinville
1880
Zwolle
TOTAL¹
¹ TOTAL must be equal to premiums reported on Form 1061, Item A1 + Item B1. Complete Reconciliation Table on next page.
Form 1076 (Revised 01/12)
THIS DOCUMENT IS EXEMPT FROM PUBLIC RECORDS LAW UNDER R.S. 44§4
Page 4 of 6

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