Form 20-Ins - Oregon Insurance Excise Tax Return - 2013
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3Clear Form
• 2013 Form 20-INS
Oregon Insurance
Excise Tax Return
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* 0 2 9 3 1 3 0 1 0 1 0 0 0 0 *
Beginning (short year only)
Ending (short year only)
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For office use only
Name:
FEIN:
BIN:
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Address:
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Payment
City:
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1
2
3
St:
ZIP code:
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New name
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New address
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Extension
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FOR FUTURE COMPUTER USE ONLY
Form 37
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Amended
Contact name:
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Contact phone:
Web:
Questions: Complete A through D only if this is your first return or the answer changed during 2013.
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A. Incorporated in (state);
Incorporated on (date)
B. State of commercial domicile
C. Date business activity began in Oregon
D. Business Activity Code
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E. (1)
Consolidated federal return;
(2)
Consolidated Oregon return;
(3)
Corporations included in consolidated federal return, but not in Oregon return
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G. Enter name of parent corporation, if applicable
Enter FEIN of parent corporation, if applicable.
F.
Low-income taxpayer
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H. Number of Oregon corporations
I. List the tax years for which federal waivers of the statute of limitations are in effect and dates on which waivers expire
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J. List the tax years for which your federal taxable income was changed by an IRS audit or by an amended annual report filed during this tax year
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K. If first return, indicate
Name of previous business
FEIN
BIN
New business, or
Successor to previous business
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L. If final return, indicate
Name of merged or reorganized corporation
FEIN
BIN
Withdrawn,
Dissolved, or
Merged or reorganized
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M. If you did not complete Schedule AP, fill in the amount of your Oregon sales ......................................
M
Income
Net income from the annual statement to the insurance commissioner:
1. Life, accident, and health companies (from page 4, line 35 of annual statement) ....1
2. Less: Income, expenses, and other items attributable to separate accounts from ‘Summary
of Operations,’ page 4, lines 5 & 8.1 of the annual statement for life companies ............2
3. Subtotal (line 1 minus line 2) .................................................................................................................. 3
4. Fire, property, and casualty companies (from page 4, line 20 of annual statement) .....4
5. Less: Underwriting profit derived from wet marine and transportation insurance ....5
6. Subtotal (line 4 minus line 5) .................................................................................................................. 6
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7. Total (line 3 plus line 6) ....................................................................................................................
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Additions
8. Federal income taxes deducted in arriving at line 7 ........................
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9. State income taxes deducted in arriving at line 7 ...........................
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10. Penalty interest on prepayment of loans .........................................
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11. Decreases in certain reserves..........................................................
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12. Total other additions (from Schedule ASC-CORP, see instructions) ....
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13. Total additions (add lines 8 through 12) ..........................................................................................
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Form 20-INS, page 1 of 3
150-102-129 (Rev. 10-13)
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