Annual Municipal Premium & Tax Report

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ONLINE FILING AVAILABLE AT
Form 478
Insurance Premium Tax
Tax Year: 2011 License Year: 2012
Annual Municipal Premium & Tax Report
Remittance Address:
LaMATS
PO Box 830725
*Specifies New LaMATS Participant
Birmingham, AL 35283-0725
Support: ipt@lamats.net
Online Filing Available:
Phone (800) 996-9573 Fax (205) 423-4099
Company
NAIC:
Mailing
Address
Contact
Direct Telephone Number
Person
Email
FEIN #
Please assist us in updating our records. Please specify the type of insurance coverage provided under the above referenced NAIC:
□ Life
□ Fire / Casualty
□ Risk
□ Title
□ Misc
□ Other
 Check here if pre-printed company information is incorrect. Please specify changes needed.
 Check here if there is no income to report. Sworn statement must be signed and dated at the bottom of the form.
Muni
Municipality
Premiums
Municipal Tax
Muni
Municipality
Premiums
Municipal Tax
Code
Liability
Code
Liability
10
Abbeville
271
Cankton
30
Addis
272
Carencro
40
Albany
274
Castor
60
Amite
276
Central
65
Anacoco
280
Chatham
68
Angie
290
Church Point
70
Arcadia
307
Clarks
80
Arnaudville
310
Clinton
95
Ashland
340
Collinston
100
Baker
345
Converse
110
Baldwin
350
Cottonport
115
Ball
360
Coushatta
120
Basile
370
Covington
125
Baskin
390
Cullen
130
Bastrop
410
Delhi
160
Bernice
420
Denham Springs
170
Berwick
430
DeQuincy
176
Village of Bienville
444
Dixie Inn
180
Blanchard
448
Dodson
190
Bogalusa
462
Dubach*
195
Bonita
464
Dubberly
210
Boyce
465
Duson
220
Breaux Bridge
480
Elton
240
Bunkie
485
Epps
270
Campti
493
Eros

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