Form M11ar - Fire Insurance Tax - 2014 Page 2
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1
22014 Form M11AR Instructions
Lines 2a and 2b
Use this form to determine the correct
7b. all comprehensive fire, theft and mis-
amount of premiums collected for all fire,
cellaneous premiums with deductibles
Enter all crop premiums written for allied
sprinkler and lightning damage. Use these
(excluding collision);
lines on line 2a and other than crop premi-
instructions as a guide. For further infor-
7c. all fire and theft combined premiums;
ums on line 2b (line 2.1, Minnesota state
mation, see M.S. 297I. The purpose of this
7d. all fire, theft and miscellaneous premi-
page).
form is to collect retaliatory tax on fire
ums;
Lines 3a and 3b
insurance premiums.
7e. all fire premiums; and
Enter all farmowners and homeowners
7f. all collision and other premiums.
Be sure to include this form when you file
multi-peril premiums written (lines 3 and 4,
your Form M11.
The total auto physical damage premiums
Minnesota state page).
listed by breakdown (lines 7a through 7f)
Filing Requirements
should equal total auto physical damage
Line 3c
premiums on the state page of your annual
Enter the nonliability portion of all com-
All insurers licensed to write fire insurance
statement.
mercial premiums written (line 5.1, Min-
in Minnesota must file Form M11AR if
nesota state page).
their home state collects a fire insurance tax.
Line 8
This report is not required for companies
Enter all aircraft physical damage premiums
Line 3d
domiciled in Minnesota, Hawaii, Massa-
(line 22, Minnesota state page).
Enter the liability portion of all commercial
chusetts, New York and Rhode Island.
premiums written (line 5.2, Minnesota state
Line 9
(M.S. 297I.05, subd. 11)
page).
Include all other premiums collected for
your home state’s fire insurance tax if not
Instructions
Line 4
already included. Provide a breakdown
Enter all inland marine premiums (line 9,
Check Boxes
schedule showing fire portion. For package
Minnesota state page).
At the top of the form, check if the return is:
policies, the fire insurance portion may be
broken out to more accurately reflect the
Line 5
• an Amended Return: Check only if you
correct portion of fire premiums. Include a
Enter all ocean marine premiums (line 8,
are amending a previously filed return
schedule detailing the breakdown.
Minnesota state page).
for the same period. Include all original
and corrected premiums on the amended
Line 6
Information and Assistance
return.
Enter all earthquake premiums (line 12,
Website:
• for No Activity: Check only if you did not
Minnesota state page).
Email:
insurance.taxes@state.mn.us
sell any insurance that had fire, lightning
Phone:
651-556-3024
or sprinkler leakage coverage for the year.
Line 7
We’ll provide information in other formats
Enter all total auto physical damage pre-
Line Instructions
upon request to persons with disabilities.
miums (lines 21.1 – 21.2, Minnesota state
Premiums include finance, service or other
page) OR:
charges paid to the insurers.
7a. all comprehensive fire, theft and
miscellaneous premiums (excluding
Line 1
collision);
Enter all fire premiums written (line 1, Min-
nesota state page).
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