Annual Tax Return - Nebraska Department Of Insurance - 2011 Page 3
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4SECTION IV – SUMMARY OF TAXES AND FEES
NEBRASKA BASIS
STATE OF DOMICILE
BASIS
18.
Premium tax (Line 11)
.00
.00
19.
Fees (Line 17)
.00
.00
20.
Total taxes and fees (Line 18 plus Line 19)
.00
.00
21.
Total taxes and fees applicable (Greater of Nebraska basis or state of
domicile basis Line 20)
.00
22.
Prepayments (April 15, June 15, September 15; payments and applied
credits)
.00
23.
Unapplied credit balance
.00
24.
Total prepayments and unapplied credits (Line 22 plus Line 23)
.00
25.
Balance due (If Line 21 is greater than Line 24, enter amount. Enclose
payment of this amount).
.00
26.
Overpayment (If Line 24 is greater than Line 21, enter amount here)
.00
27.
Amount to be refunded
.00
28.
Amount to be credited to 2012 prepayment
.00
FOR TITLE P/C 2011
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