Bail Bond Companies Premium Tax - South Dakota Division Of Insurance - 2011 Page 5
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2
3
4
5COMPANY NAME ______________________________________NAIC #_________
Computation of Net Taxes and Retaliatory Fees
Column 1
Column 2
State of Incorporation
South Dakota Basis
Amounts Paid During Calendar Year 2011:
Basis
25. Agents' license and/or appointment fees _______________________________
$
$
26. Filing Amendments to Articles of Incorporation or Charter ________________
27. Filing Amendments to Bylaws ______________________________________
28. Rate and form filing fees ___________________________________________
29. Fraud Unit Assessment ____________________________________________
NONE
30. Other Fees including retaliatory (ITEMIZE)____________________________
_______________________________________________________________
_______________________________________________________________
31. Total (Lines 25 through 30) _____________________________________
$
$
Total Aggregate Liability
32. Fees – Enter total of lines 5 and 31 __________________________________
$
$
33. Premium Taxes (Lines 9, 15 and 24 )________________________________
$
$
34. If Line 33 is less than $500, then enter $500 minus line 33 -- Column. 2 only__
XXX
$
$
35. Total licenses, fees, and taxes (lines 32 through 34 )_____________________
$
36. Enter Greater of Column 1 or 2, line 35______________________________
Less Credits
37. Enter the amount already paid from Line 31, column 2. _____________________
37.
$
38.
38. Enter total of quarterly premium tax payments ____________________________
$
39. IF APPLICABLE, enter the amount of the 2010 overpayment that was credited
$
39.
towards 2011 tax year. Must not have been previously refunded. _____________
40.
40. Home Office Credit _________________________________________________
$
$
NONE
41. Life & Health Guaranty Fund Credit ____________________________________
41.
AVAILABLE
42.
42. Credit from a company merging into this reporting company _________________
$
43. Total (Lines 37 through 42) __________________________________________
43.
$
Balance Due
. Net taxes and retaliatory fees due (Line 36 less 43)
$
44
________________
POSTMARKS AFTER MARCH 1, 2012 WILL BE SUBJECT TO 1½ % PENALTY FEE.
.
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