Form 1061 - Annual Premium Tax Statement - Louisiana Department Of Insurance - 2011
Download a blank fillable Form 1061 - Annual Premium Tax Statement - Louisiana Department Of Insurance - 2011 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 1061 - Annual Premium Tax Statement - Louisiana Department Of Insurance - 2011 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6Louisiana Department of Insurance
Form 1061
2011 Annual Premium
Tax Division
P. O. Box 94214
Tax Statement
Baton Rouge, LA 70804-9214
Phone (225) 342-5825
Fax (225) 342-9708
Due March 1, 2012
Company Name
Mailing Address
Box or Suite
City, State, Zip
Contact Person
E-Mail Address
Telephone Number
Fax Number
State of Domicile
Federal ID Number
NAIC Number
LDI Number
F
A
/L
I
, R
R
G
(
6)
OR
DMITTED
ICENSED
NSURERS
ISK
ETENTION
ROUPS
SEE INSTRUCTIONS ON PAGE
Item A: Fire, Marine, Transportation, Casualty, Surety, Title and Miscellaneous Premium Tax Calculation: (L.R.S. 22§831)
1. Net Taxable Premium. (From Schedule A, Line B)
$
$
2. Gross Tax Calculation - From Tax Table 1065A-P&C - Minimum tax is $185.00
$
3. Investment Credit allowed under L.R.S. 22§832. [(Schedule D, Line 4) x Line 2]
4. Investment Credit Under Provisions of L.R.S. 22§832(E)- (CAPCO)
$
5. Louisiana Insurance Guaranty Association Assessment (
All Credits Refunded Dec, ’09
)
$
6. Net Tax: [(Line 2 – (Line 3 + Line 4 + Line 5)]; If less than zero, enter –0-.
Item B: Life, Accident and Health Premium Tax Calculation (L.R.S. 22§842)
$
1. Net Taxable Premium. (From Schedule B, Line B)
$
2. Gross Tax Calculation. (From Tax Table 1062A-LA&H); Minimum Tax: $140.00
$
3. Investment Credit allowed under L.R.S. 22§832. [(Schedule D, Line 4) x Line 2]
$
4. Investment Credit Under Provisions of L.R.S. 22§832(E). (CAPCO)
5. Louisiana Life and Health Insurance Guaranty Association Credit. (From Schedule F, Line A)
$
$
6. Net Tax: [Line 2 less (Lines 3 +Line 4 + Line 5); If less than zero, enter –0-.
Item C: Fire Marshal, Fire Department and Firemen Training Program Tax (L.R.S. 22§835, 345 and 837)
$
1.
Taxable Premiums Allocated to Fire Tax (From Schedule A, Line 35, Column 3)
$
2.
Fire Marshall Tax (From Schedule A, Line C)
$
3.
Fire Department Tax (From Schedule A, Line D)
$
4.
Fireman Training Tax (From Schedule A, Line E)
$
5.
Fire Tax Total (Line 2 + Line 3+ Line 4); If less than zero, enter -0-.
Item D: Retaliatory Taxes - Foreign Companies Only
$
1. Total retaliatory taxes from Schedule C, Line A
Item E: Summary of Taxes Due or Overpayment
1. Total Tax (Item A + Item B + Item C + Item D)
$
2. Military Discount Credit (Attach Form 1425)
$
3. Total Quarterly Prepayments
$
4. Carry forward from Previous Tax Years
$
5. Annual Financial Regulation Fee $1,000 (Not applicable to Risk Retention Groups)
$
6 Penalty as provided by L.R.S. 22§846, if applicable.
$
7. Tax, Fee and Penalty Due or Overpayment: (Line 1 - Line 2 - Line 3 – Line 4 + Line 5 + Line 6)
$
Attach a payment for the above amount payable to the Commissioner of Insurance, State of Louisiana, and record the amount in the space provided
b l
Tax, Fee and Penalty Due
$
Payment method (check one):
Check
Bank Wire
ACH Credit
Not Applicable
Form 1061 (Revised 10-11)
THIS DOCUMENT IS EXEMPT FROM PUBLIC RECORDS LAW UNDER L.R.S. 44§4
Page 1 of 6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 1076 - Annual Municipal Premium & Tax Report - Louisiana Department Of Insurance - 2011
Financial
Form Pf-y - Annual Premium Tax Statement For A Foreign Insurance Company - Alabama Department Of Insurance
Legal
Related Categories
Parent category: Financial