Form 20-Ins - Oregon Insurance Excise Tax Return - 1999
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OREGON
Date received
•
Form
INSURANCE
1999
20 -INS
Payment
•
EXCISE TAX
•
•
1
2
3
RETURN
•
•
•
SHORT YEAR ONLY
Mo
Day
Year
Mo
Day
Year
If you filed a return in 1998, indicate if you
•
•
99
Beginning:
Ending:
had a:
Name change
Address change
Name
Federal employer ID number
Business identification number
•
Mailing address
•
An extension is attached
State
ZIP Code
City
•
Form 37 is attached
Contact person
Telephone number
•
This is an amended return
(
)
•
Complete A through D only if this is your first return or the answer
H.
List the tax years for which federal waivers of the statute of limitations
changed during 1999.
are in effect and dates on which waivers expire:
•
A.
Incorporated in
(state), on
(date)
•
•
B.
State of commercial domicile
I.
List the tax years for which your federal taxable income was changed
•
C.
Date began business activity in Oregon
by an IRS audit, or by an amended federal return filed during this tax
•
D.
Business Activity Code from your federal return
year:
•
If the change affects your Oregon excise tax, send a copy of the
E.
(1) Was a consolidated federal return filed?
.............
Yes
No
Yes
agent’s report or the amended return under separate cover.
(2) Is this a consolidated Oregon return?
.................
No
•
J.
If this is your first return, indicate whether:
(3)
Are corporations included in the consolidated
New business, or
Successor to previously existing business.
federal return, but not in the Oregon return?
.......
Yes
No
Enter name and federal employer ID number of previous business:
If (1), (2) or (3) is yes, see instructions on page 3.
F.
If you have more than 12 affiliates doing business
•
K.
If this is your final return, indicate whether:
Withdrawn
Dissolved
in Oregon, check the box and see instructions on page 3
.........
•
G.
Are you a high-income taxpayer? Please see
Merged or reorganized. Enter name and federal employer ID # of
instructions on page 3
..............................................
Yes
No
merged or reorganized corporation:
Net income from the Annual Statement to the Insurance Commissioner:
1
1.
Life and accident and health companies (from page 4, line 33 of the annual statement)
.................
2
2.
Less: income, expenses and other items attributable to separate accounts (see page 3) ................
Subtotal (line 1 minus line 2) .............................................................................................................................................
3
3.
4
4.
Fire, property and casualty companies (from page 4, line 16 of the annual statement)
....................
5
5.
Less: underwriting profit derived from wet marine and transportation insurance (see page 3)
.........
6
6.
Subtotal (line 4 minus line 5)
.............................................................................................................................................
•
7
.....................................................................................................................................................
7.
Total (line 3 plus line 6)
ADDITIONS (see instructions, pages 3 and 4)
•
8
8.
Federal income taxes deducted in arriving at line 7
..........................................................................
•
9
9.
State income taxes deducted in arriving at line 7
..............................................................................
•
10
10.
Penalty interest on prepayment of loans
...........................................................................................
•
11
11.
Realized gains and losses excluded from line 7
...............................................................................
•
12
12.
Decreases in certain reserves
...........................................................................................................
13
13.
.............................................................................................................................
Total additions (add lines 8 through 12)
14
14.
Income after additions (line 7 plus line 13)
........................................................................................................................
SUBTRACTIONS (see instructions, page 4)
•
15
15.
Amortization of past service credits
..................................................................................................
•
16
Increases in certain reserves
16.
............................................................................................................
•
17
17.
Depreciation in excess of annual statement allowance
....................................................................
18
18.
Total subtractions (add lines 15 through 17) .....................................................................................................................
19
19.
Income before net loss deduction (line 14 minus line 18) (carry forward to page 2, line 20) .............................................
150-102-129 (Rev. 9-99)
Now go to the back of this form
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