Form 207 Esa - Estimated Insurance Premiums Tax Payment Coupon Domestic Insurance Companies

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207 ESA - First Installment
Department of Revenue Services
207 ESA
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
PO Box 2990
Domestic 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 30% (.30) of the tax shown on 2014 Form 207, Line 9.
1
2
Enter amount from Schedule 1, Line 4, on back of this form.
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
Due Date: March 15, 2015
Please change
Make Check Payable To:
name or
Commissioner of Revenue Services
mailing 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
207 ESB - Second Installment
Department of Revenue Services
207 ESB
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
PO Box 2990
Domestic 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 60% (.60) of the tax shown on 2014 Form 207, Line 9.
1
2
Enter amount from Schedule 1, Line 4, on back of this form.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207 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
Due Date: June 15, 2015
Please change
Make Check Payable To:
name or
Commissioner of Revenue Services
mailing address,
or both,
Pay electronically at
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990
207 ESC - Third Installment
Department of Revenue Services
207 ESC
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
PO Box 2990
Domestic 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 80% (.80) of the tax shown on 2014 Form 207, Line 9.
1
2
Enter amount from Schedule 1, Line 4, on back of this form.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207 ESA and 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
Due Date: September 15, 2015
Please change
Make Check Payable To:
name or
Commissioner of Revenue Services
mailing 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
207 ESD - Fourth Installment
Department of Revenue Services
207 ESD
State of Connecticut
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
PO Box 2990
Domestic 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 207, Line 9.
1
2
Enter amount from Schedule 1, Line 4, on back of this form.
2
Date received (DRS use only)
3
Enter the lesser of Line 1 or Line 2.
3
4
Enter amount paid with Form 207 ESA, ESB, and ESC plus overpayment
Federal Employer ID Number (FEIN)
from prior year applied to estimated tax for current year.
4
5
Payment due with this coupon: Subtract Line 4 from Line 3.
5
Due Date: December 15, 2015
Please change
Make Check Payable To:
name or
Commissioner of Revenue Services
mailing address,
or both,
Pay electronically at
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right.
PO Box 2990
Hartford CT 06104-2990

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