Form 74a100 - Insurance Premiums Tax Return - 2002 Page 2
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474A100 (12-02)
Page 2
SECTION I. DOMESTIC AND FOREIGN LIFE INSURANCE TAX (Kentucky Revised Statute 136.330)
(A) Life Insurance
A.
Life insurance premiums
1.
Total premium receipts ........................................................................................................
2.
Returned premiums .............................................................................................................
3.
Net premiums (subtract line 2 from line 1) .....................................................................................................................
B.
Accident and health premiums
1.
Premium receipts ................................................................................................................
2.
a. Returned premiums ..............................................................
b. Dividends on accident and health policies ............................
3.
Total (add lines 2a and 2b) ..................................................................................................
4.
Net premiums—accident and health (subtract line 3 from line 1) ...................................................................................
C.
Dividends applied to purchase paid-up additions ....................................................................................................................
D.
Premiums received on reinsurance assumed on Kentucky risks from unauthorized companies
(Attach itemized account of all reinsurance assumed on Kentucky risks.) ...............................................................................
E.
Total taxable premiums (add lines A-3, B-4, C and D) ...........................................................................................................
F.
Domestic and foreign life insurance tax liability (1.7% of line E) ...........................................................................................
G.
Credits
1.
Life and Health Guaranty Fund Assessment Credit .............................................................
2.
Kentucky Investment Fund Act Credit ................................................................................
3.
Total of lines 1 and 2 ......................................................................................................................................................
H.
Net domestic and foreign life insurance tax liability (subtract line G3 from line F; if line G3 exceeds line F, enter zero) .......
First Installment
Second Installment
I.
1.
Domestic and foreign life insurance tax paid by declaration .........
2.
Adjustment (attach documentation) .....................................................................................
3.
Total lines I-1 and I-2 .....................................................................................................................................................
J.
Net domestic and foreign life insurance tax due (subtract line I-3 from line H and enter here and on line A, page 1) ..............
$
LIFE AND HEALTH GUARANTY FUND ASESSMENT SCHEDULE
Payment Year
Total Assessment Paid
20 Percent Rate Credit
1997
______________________________
____________________________
1998
______________________________
____________________________
1999
______________________________
____________________________
2000
______________________________
____________________________
2001
______________________________
____________________________
(
)
(
)
Refunds
______________________________
____________________________
TOTALS
______________________________
____________________________
(enter amount in Section I, line G
or
Section II, line I)
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Parent category: Financial