Form Ins-1 - Estimated Quarterly Return Premium And/or Worker'S Compensation Insurance Tax - 2004

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*0430001*
FORM INS-1
2004
MAINE REVENUE SERVICES
00
ESTIMATED QUARTERLY RETURN
*0430001*
PREMIUM AND/OR WORKERS’ COMPENSATION INSURANCE TAX
Account ID No.
Period Begin
Period End
Due Date
Entity Information:
This return is made in compliance with the provisions of 36 M.R.S.A. § 2521-A.
,
,
.
1. Quarterly Estimate
a. PREMIUM ................................................................................................... 1a.
,
,
.
b. WORKERS’ COMP. .................................................................................... 1b.
,
,
.
c. TOTAL (line 1a plus line 1b) ..................................................................... 1c.
,
,
2. Less: Prior Credit (if any) ........................................................................................................................ 2.
.
3. TOTAL Remittance with Return (line 1c less line 2; if less than zero, enter zero) ................................. 3.
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,
.
DATE _____________________________________
*BY ______________________________
TEL. _____________________________________
TITLE ____________________________
*Must be signed by the President, Treasurer, Secretary, Chief Accounting Officer, or Attorney-in-Fact of a Reciprocal Insurer. See instructions below.
CONTACT PERSON ___________________________________
SPECIFIC INSTRUCTIONS
Line 1: Quarterly Estimate. For each of the first and second quarters, this line must equal 35% of total annual liability. For the third quarter,
this line must equal 15% of total annual liability.
Line 2: Prior Credit. If the reconciliation return (Form INS-4) for the previous year shows an overpayment, subtract the overpayment from the
quarterly payment(s) due for the current year.
INTEREST & PENALTY
Annually, the State Tax Assessor establishes the interest rate by rule. Beginning January 1, 2004 the interest rate is 0.5% per month.
The penalty for failure to file a return is the greater of $25 or 10% of the tax due, unless the return is filed more than 30 days after the receipt of a
demand notice from the State Tax Assessor, in which case the failure-to-file penalty becomes 100% of the tax otherwise due.
The penalty for failure to pay a tax liability timely is the greater of 1% of the outstanding liability for each month or fraction thereof during which
the failure continues, to a maximum of 25% of the outstanding liability.
MAKE CHECK PAYABLE TO:
TREASURER, STATE OF MAINE
SEND CHECK &
MAINE REVENUE SERVICES
REMITTANCE MUST ACCOMPANY RETURN.
RETURN TO:
P.O. BOX 1064
AUGUSTA, ME 04332-1064.
Office use only
INS-1 Rev. 08/03

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