Form 25-100 - Texas Annual Insurance Premium Tax Report
Download a blank fillable Form 25-100 - Texas Annual Insurance Premium Tax Report 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 25-100 - Texas Annual Insurance Premium Tax Report 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
125-100
b.
(Rev.11-00/9)
TEXAS ANNUAL INSURANCE PREMIUM TAX REPORT
(Licensed Companies and Miscellaneous Organizations)
71100
a. T Code
A report must be filed even if no tax is due.
f. Due date
c. Taxpayer number
d. Filing period
e.
g. Taxpayer name and tax report mailing address (Make any necessary name and address changes below)
IMPORTANT
h.
Blacken this box if your mailing
address has changed. Show changes
1.
by the preprinted information.
i.
j.
1. Gross life premiums or HMO revenues
(Dollars and cents)
1.
2. Non-taxable premiums
(From Form 25-205)
2.
3. Taxable premiums
(Item 1 minus Item 2)
3.
4. Enter the smaller of Item 3 or $450,000
4.
0 0 8 7 5
5. Tax rate
5.
6. Tax due
(Multiply Item 4 by Item 5. Dollars and cents)
6.
7. Enter the premiums over $450,000
(Dollars and cents)
7.
0 1 7 5 0
8. Tax rate
8.
9. Tax due
(Multiply Item 7 by Item 8)
9.
10. TOTAL TAX DUE
(Item 6 plus Item 9)
10.
11. Gross accident and health premiums
11.
(Dollars and cents)
12. Employee contribution for benefit plans
12.
(Not included in Item 11)
13. Non-taxable premiums
13.
(From Form 25-205)
14. Taxable accident and health premiums
14.
(Item 11 plus Item 12 minus Item 13)
0 1 7 5 0
15. Tax rate
15.
16. TOTAL TAX DUE
16.
(Multiply Item 14 by Item 15. If less than zero, see instructions.)
17. Gross property and/or casualty or title premiums
(Dollars and cents)
17.
18. Non-taxable premiums
(From Form 25-205)
18.
19. Taxable premiums
(Item 17 minus Item 18)
19.
20. Tax rate
(See instructions)
20.
21. TOTAL TAX DUE
(Multiply Item 19 by Item 20. If less than zero, enter 0.)
21.
22. TOTAL PREMIUM TAX DUE
(Total of Items 10, 16 and 21. If less than zero, enter 0.)
22.
23. Credits
(See instructions)
23.
24. Assessment credits
(See instructions)
24.
25. NET PREMIUM TAX DUE
(Item 22 minus Items 23 & 24. If less than zero, enter 0.)
25.
26. Total prior payments
26.
27. PREMIUM TAX DUE AND PAYABLE
(Item 25 minus Item 26)
27.
* * * DO NOT DETACH * * *
Form 25-100 (Rev.11-00/9)
28. Penalty and interest
(See instructions)
28.
29. TOTAL AMOUNT DUE AND PAYABLE
(Item 27 plus Item 28)
29.
k.
l.
Taxpayer name
T Code
Taxpayer number
Period
I declare that the information in this document and all attachments is true and correct
to the best of my knowledge and belief.
Authorized agent
Preparer's name (Please print)
Make the amount in Item 29 payable to STATE COMPTROLLER. Our
mailing address is 111 E. 17th Street, Austin, TX 78774-0100.
Daytime phone
Date
(Area code & number)
If you have any questions regarding Insurance Tax, you may contact the Texas State
Comptroller's field office in your area or call 1-800-252-1387, toll free, nationwide. The
Austin number is 512/463-4600. If you're calling from a Telecommunications Device
for the Deaf (TDD), the toll-free number is 1-800-248-4099, or in Austin, 512/463-4621.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial