Sd Eform 2258 - Premium Tax Return Voucher For South Dakota - 2013

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SD EForm - 2258
V2
HELP
SOUTH DAKOTA DIVISION OF INSURANCE
445 East Capitol Avenue -- Pierre, SD 57501
605-773-3563
2013 PREMIUM TAX RETURN INSTRUCTIONS
FOR SOUTH DAKOTA
(LIFE AND HEALTH)
Please note – Per SDCL 10-44-2, the tax return and the check/payment voucher must be postmarked ON OR
BEFORE March 1, 2014. Any postmark after that date will be subject to a penalty fee of 1.5% per month.
NEW THIS YEAR: COMPLETE THE PREMIUM TAX RETURN ELECTRONICALLY.
Go to
to complete the form and get further instructions.
You are required to electronically attach a copy of the State Page and Schedule T along with any other
supporting documents to the electronic filing of the tax return.
DO NOT send those required attachments
under separate cover to our office.
All payments should be remitted by check and made payable to the SD Division of Insurance. Print the below
payment voucher and mail the check and voucher to:
South Dakota Remittance Center
OR
South Dakota Remittance Center
(ground delivery)
PO Box 5055
300 So. Sycamore Avenue STE #102
Sioux Falls, SD 57117-5055
Sioux Falls, SD 57110
------- 
------
PLEASE DETACH UPPER SECTION BEFORE MAILING
** PAYMENT VOUCHER FOR SOUTH DAKOTA **
2013 YEAR END PREMIUM TAX – POSTMARKED BY MARCH 1, 2014
_______________________________________________________________________________________________________________
ATTACH PAYMENT TO THIS VOUCHER AND MAIL TO:
SOUTH DAKOTA REMITTANCE CENTER
PO Box 5055 – Sioux Falls, SD 57117
Or ground delivery: 300 S. Sycamore Ave., Ste. #102 - Sioux Falls, SD 57110
POSTMARKED NO LATER THAN MARCH 1, 2014
COMPANY NAME: _______________________________________________________________
NAIC # ___________________
CONTACT NAME: _______________________________________________________________
PHONE: __________________
$
AMOUNT SUBMITTED --
Round to nearest dollar
PRINT FOR MAILING
CLEAR FORM

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