Form Prt1 - Privilege And Retaliatory Tax Quarterly Installment - State Of Illinois
ADVERTISEMENT
1IL Department of Insurance
State of Illinois
P.O. Box 7087
Privilege and Retaliatory Tax Quarterly Installment
Springfield, IL 62791
All companies whose annual tax for the preceding calendar year was less than $5,000 need not
file this installment.
Web Site: (Department Links>Industry>Company Information>Tax Forms)
2010 Calendar Year--
Federal Employer Identification Number:
Indicate which filing:
April 15, 2010
By the
Insurance Company
June 15, 2010
September 15, 2010
of
December 15, 2010
State
Street and Number
City
Zip Code
Privilege Tax
PART A-BASED ON PRIOR YEAR TOTAL TAX
1. 2009 Privilege Tax from Page 6, Line 1 of the Privilege and Retaliatory Tax Return ....................... $ ____________________
2. Installment amount due is 1/4 of Line 1 ........................................................................................... $____________________
PART B-BASED ON CURRENT CALENDAR YEAR
3. 2010 Estimated Privilege Tax on taxable premiums ........................................................................ $____________________
3a.
Less: Estimated Fire Department Taxes to be paid in 2010, if applicable ............................. $____________________
3b.
Less: Estimated Intergradation 2010 excess Income Tax Offset, if applicable ...................... $____________________
4. Net Privilege Tax for 2010 (Line 3 minus sum of 3a and 3b) ........................................................... $____________________
5. 80% of Line 4 to be paid in 2010 ..................................................................................................... $____________________
6. Installment amount due is 1/4 of Line 5 ........................................................................................... $____________________
Retaliatory Tax
PART A-BASED ON PRIOR YEAR TOTAL TAX
7. 2009 Retaliatory Tax from Page 6, Line 2 of Privilege and Retaliatory Tax Return ......................... $____________________
8. Installment amount due is 1/4 of Line 7 ........................................................................................... $____________________
PART B-BASED ON CURRENT CALENDAR YEAR
9. 80% of 2010 Estimated Retaliatory Tax ........................................................................................... $____________________
10. Installment amount due is 1/4 of Line 9 ........................................................................................... $____________________
Payment
11. Amount due as a Privilege Tax from Line 2 or Line 6 ...................................................................... $ ____________________
12. Amount due as a Retaliatory Tax either Line 8 or Line 10 ............................................................... $____________________
13. Amount due this installment, Line 11 plus Line 12 ........................................................................... $____________________
14. Less: Prior calendar year Privilege or Retaliatory Tax overpayment
(amount may not be more than Line 13) ......................................................................................... $____________________
15. Amount of tax payment due this installment, Line 13 minus Line 14 ............................................... $____________________
16. Penalty for failure to file tax statement ($400/month or 10% of tax, whichever is greater) .............. $____________________
17. Penalty for failure to pay tax (10% of tax due) ................................................................................. $____________________
18. Interest on tax paid after due date (current IRS rate or 12% minimum) .......................................... $____________________
19. Total penalty and interest (add lines 16 through 18) ........................................................................ $____________________
20. Balance due (Line 15 plus Line 19) ................................................................................................. $____________________
I certify that this is a true, correct and complete Declaration of taxes due (print name).
Date
Phone
Signature of Company Officer
Please complete and return one copy of this tax installment each quarter. The official filing date is the U.S. Postal date per 50 Ill.
Adm. Code 2500.60. Remittance should be payable to the Illinois State Treasurer and mailed to: Illinois Department of
Insurance, P.O. Box 7087, Springfield, Illinois 62791.
Important Notice: Disclosure of this information is required under the Illinois Compiled Statutes' insurance laws. Failure to provide this
information could result in a fine. This form has been approved by the Forms Management Center.
PRT1 (12/09 PD)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Prt1 - Privilege And Retaliatory Tax Quarterly Installment - Illinois Department Of Insurance
Financial
Form Prt1 - Privilege And Retaliatory Tax Quarterly Installment - Il Department Of Insurance
Financial
Form Il446-0126-l - 2011 Privilege And Retaliatory Tax Return For Life And Accident And Health Companies - Illinois Department Of Insurance
Financial
Form Il446-0126-p - 2010 Privilege And Retaliatory Tax Return For Property And Casualty Insurers Form - Illinois Department Of Insurance
Financial
Form Il 446-0126-r - Privilege And Retaliatory Tax Return For Risk Retention Groups - 2010
Financial
Form Il 446-0126-r - 2012 Privilege And Retaliatory Tax Return For Risk Retention Groups (rrg)
Financial
Related Categories
Parent category: Financial