Form 207f - Estimated Insurance Premiums Tax Payment Coupon Nonresident And Foreign Insurance Companies

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207F ESA - First Installment
Department of Revenue Services
207F ESA
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Nonresident and Foreign Insurance Companies
PO Box 2990
Hartford CT 06104-2990
(Rev. 01/15)
Complete this coupon in blue or black ink only.
CT Insurance Premiums Tax Reg. No.
1
Enter 30% (.30) of the tax shown on 2014 Form 207F, Line 16.
1
2
Enter amount from Schedule 1, Line 4, on back.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter overpayment from prior year applied to estimated tax for current year.
4
Federal Employer ID Number (FEIN)
5
Payment due with this coupon: Subtract Line 4 from Line 3.
5
Please
Due Date: March 15, 2015
change
Make Check Payable To:
name or
mailing
Commissioner of Revenue Services
address,
Pay electronically at
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990
207F ESB - Second Installment
Department of Revenue Services
207F ESB
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Nonresident and Foreign Insurance Companies
PO Box 2990
Hartford CT 06104-2990
(Rev. 01/15)
Complete this coupon in blue or black ink only.
CT Insurance Premiums Tax Reg. No.
1
Enter 60% (.60) of the tax shown on 2014 Form 207F, Line 16.
1
2
Enter amount from Schedule 1, Line 4, on back.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207F ESA plus overpayment from prior year
Federal Employer ID Number (FEIN)
applied to estimated tax for current year.
4
5
Payment due with this coupon: Subtract Line 4 from Line 3.
5
Please
Due Date: June 15, 2015
change
Make Check Payable To:
name or
mailing
Commissioner of Revenue Services
address,
Pay electronically at
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990
207F ESC - Third Installment
Department of Revenue Services
207F ESC
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Nonresident and Foreign Insurance Companies
PO Box 2990
Hartford CT 06104-2990
(Rev. 01/15)
Complete this coupon in blue or black ink only.
CT Insurance Premiums Tax Reg. No.
1
Enter 80% (.80) of the tax shown on 2014 Form 207F, Line 16.
1
2
Enter amount from Schedule 1, Line 4, on back.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207F ESA and 207F ESB plus overpayment from
Federal Employer ID Number (FEIN)
prior year applied to estimated tax for current year.
4
5
Payment due with this coupon: Subtract Line 4 from Line 3.
5
Please
Due Date: September 15, 2015
change
Make Check Payable To:
name or
mailing
Commissioner of Revenue Services
address,
Pay electronically at
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990
207F ESD - Fourth Installment
Department of Revenue Services
207F ESD
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
PO Box 2990
Nonresident and Foreign Insurance Companies
Hartford CT 06104-2990
(Rev. 01/15)
Complete this coupon in blue or black ink only.
CT Insurance Premiums Tax Reg. No.
1
Enter the tax shown on 2014 Form 207F, Line 16.
1
2
Enter amount from Schedule 1, Line 4, on back.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207F ESA, 207F ESB and 207F ESC plus
Federal Employer ID Number (FEIN)
overpayment from prior year applied to estimated tax for current year.
4
5
Payment due with this coupon: Subtract Line 4 from Line 3.
5
Please
Due Date: December 15, 2015
change
Make Check Payable To:
name or
mailing
Commissioner of Revenue Services
address,
Pay electronically at
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990

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