Form M11 - Insurance Premium Tax Return For Property And Casualty Companies - 2014
Download a blank fillable Form M11 - Insurance Premium Tax Return For Property And Casualty Companies - 2014 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form M11 - Insurance Premium Tax Return For Property And Casualty Companies - 2014 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6M11
Page 1
2014 Insurance Premium Tax Return for Property and Casualty Companies
Due March 1, 2015
Check if:
Amended Return
Name of Insurance Company
FEIN
Minnesota Tax ID (required)
Mailing Address
Check if New Address
NAIC Number
State/Country of Incorporation
City
State
Zip Code
Contact Person
Email Address
Website Address
Daytime Phone
Fax Number
Type of Company
Date Licensed in Minnesota
Stock
Mutual
Other:
Type of Premiums (Check All That Apply)
Auto
Fire/Property
Bail Bonds
Title
Liability
Other
This Return Includes:
M11B
IG259
IG258
M11AR
A - State of Incorporation Basis
B - Minnesota Basis
Property, Casualty and Title Premiums
1 Minnesota fire and other premiums (see instructions) . . . . . . . . . . . . . . . . . . 1
2 Accident and health premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Total Minnesota direct business (add lines 1 and 2) . . . . . . . . . . . . . . . . . . . 3
4 Minnesota business assumed from unauthorized insurers (reinsurance) . . 4
5 Other additions (itemize on a separate schedule) . . . . . . . . . . . . . . . . . . . . . . 5
6 Gross taxable business (add lines 3 through 5) . . . . . . . . . . . . . . . . . . . . . . . 6
7 Direct ocean-marine premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Dividends paid in cash (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Other nontaxable business and dividends (attach a schedule) . . . . . . . . . . . 9
10 Total deductions (add lines 7 through 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Net taxable business (subtract line 10 from line 6) . . . . . . . . . . . . . . . . . . . 11
Continue on line 15 of page 2.
12 Tax due (or overpaid) . Enter amount from line 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 a Additional charge for underpaying estimated tax
(determine from worksheet in the instructions, page 4) . . . . . . . . . . . 13a
b Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b
c Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13c
Total (add lines 13a through 13c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 TOTAL AMOUNT DUE (or overpaid) (add lines 12 and 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
If you owe additional tax:
Payment method:
Electronic payment
Check
(payable to Minnesota Revenue; write MN tax ID number on check; attach voucher)
Enter amount paid
Date paid
(If amount paid is different from amount due on line 14, attach an explanation .)
If you overpaid:
Amount on line 14 to be credited to next year’s estimated tax . . . . . . . . . . . . . . . . . . . . .
Amount on line 14 to be refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I declare that this return is correct and complete to the best of my knowledge and belief .
I confess judgment to the state of Minnesota for the amount of tax shown due to the extent not timely paid .
Authorized Signature
Title
Date
Daytime Phone
I authorize the Minnesota
Department of Revenue to
discuss this tax return with
Signature of Preparer
Print Name of Preparer
Date
Daytime Phone
the preparer .
Mail to: Minnesota Revenue, Mail Station 1780, St . Paul, MN 55145-1780 . Do not send to the Minnesota Department of Commerce .
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial