Form Lgt 140 - City, County, Or Urban County Government Insurance Premium Tax Annual Reconciliation Page 4
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5INSTRUCTIONS FOR FILING LOCAL GOVERNMENT INSURANCE
PREMIUM TAX ANNUAL RECONCILIATION (FORM LGT 140)
(KRS 91A.080, 806 KAR 2:095, and 2:097)
ST
1. THIS FORM MUST BE FILED ON OR BEFORE MARCH 31
OF EACH YEAR with the local government to which it
applies, and a copy to the Department of Insurance, Local Government Premium Tax Unit, P.O. Box 517, Frankfort,
Kentucky, 40602, accompanied by a $5.00 fee per insurance company/surplus lines broker payable to the Kentucky State
Treasurer. Where there are no premiums collected within any of the taxing authorities, see #6 below. Inquiries regarding
the preparation of the annual reconciliation should be directed to the address above or by calling 502-564-1649. You can
also contact the Louisville Metro Revenue Commission at (502) 574-4860. Our office is located at 617 West Jefferson
Street, Louisville, Kentucky 40202.
2. EACH INSURANCE COMPANY/SURPLUS LINES BROKER MUST FILE.
GROUP FILINGS ARE NOT
ACCEPTABLE. Always give the employer identification number assigned by the IRS and other required information,
including the telephone number of the person preparing the return. Please do not staple the filings.
3. Each tax return for each local government must bear the certification (signature of preparer and date prepared) as shown on
the return.
4. Any license fee or tax not paid on or before the due date shall bear interest at the tax interest rate as defined in KRS
131.010(6) from the date due until paid. Such interest is payable to the local governments.
5. The tax rates may change effective July 1. Be certain to obtain the correct tax percentage from the Kentucky Department of
Insurance.
6. If the insurance company/surplus lines broker has collected no premiums within any taxing authority for the kinds of
insurance subject to this tax, the insurance company/surplus lines broker shall notify the Department of Insurance by
completing Form LGT-140 and state the reason that no Kentucky Local Government Premium Taxes were due. This report
shall contain the signature of the company official or other person responsible for preparing the report and be accompanied
by a fee of $5.00 per insurance company/surplus lines broker. An insurance company/surplus lines broker shall not file
Form LGT-140 with local governments where the tax liability is “NONE”.
7. Reports that are not legible will not be accepted.
8. Annual reconciliations must be filed by tax year. We cannot approve more than one form per company for this local
government. When errors are found, a new annual reconciliation must be completed in its entirety and amended to include
corrections. Submit the amended form to this local government along with additional money due, if applicable, and a copy
of the form to the Department of Insurance.
9. SPECIAL INSTRUCTIONS RELATED TO SURPLUS LINES BROKERS
Annual reconciliations shall be filed with the Department of Insurance and the applicable local government by the surplus
lines broker. Each return submitted to the local governments shall include a listing of the insurance companies that supplied
the coverage for which the premiums and taxes are being reported. This information shall be listed in Section III of Form
LGT-140. Please note that surplus lines brokers are not required to submit a separate Form LGT-140 to each local
government for each insurance company through which insurance business was exported.
10. PROPER COMPLETION OF THE ANNUAL RECONCILIATION
The Department of Insurance has automated the Kentucky Local Government Premium Tax information.
A. SECTION I
QUARTERLY INFORMATION:
Column 1: Use the tax rate in effect for each quarter for each line of coverage. If premiums were returned at a
different rate, they must be listed as a separate line item within that line of coverage.
Column 2: Include all premiums received at an insurance company’s home, administrative, or regional offices
during a calendar quarter for the lines of coverage subject to LGPT. This column is for the reporting of
premiums only. Do not add the amount of taxes collected or paid to the amount reported in this column.
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