Premium Tax Report Multi-State Independently Procured Unauthorized - New Hampshire Insurance Department Page 2

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Schedule A Multi-State Independently
Procured
Property/Risk
State
Allocation
Total
Allocation
Tax
Allocated
Tax
Location
with
Method
Premium
Percentage
Rate
Premium
Amount
Risk
Amount
Location
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

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