Form Ib-33 - Gross Premium Tax Return Property And Casualty Companies Page 3

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Legal Name
FEIN
Page 3, Form IB-33, Web, 12-12
Part 3.
Computation of Gross Premium Tax
(continued)
,
,
,
.
12.
Amount of Line 11 to be Applied to 2013 Gross Premium Tax
00
12.
,
,
,
.
13. Gross Premium Tax to be Refunded
00
13.
Line 11 minus Line 12
Schedule C. Insurance Regulatory Charge
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,
,
.
1. Gross Premium Tax Liability
00
1.
(From Schedule B, Part 1, Total Tax Computed)
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,
,
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2. Additional Tax on Property Coverage Contracts
00
2.
(From Schedule F, Line 14)
,
,
,
.
3. Total Gross Premium Tax Liability
00
3.
Add Lines 1 and 2
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,
,
.
4. Insurance Regulatory Charge
00
4.
Multiply Line 3 by 6.0%
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,
,
.
5. Prior Year Credit Applied to 2012
00
5.
(From Schedule D, Line 1, Column 2)
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,
,
.
6. Insurance Regulatory Charge Installment Payments
00
6.
(From Schedule D, Line 5, Column 2)
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,
,
.
7. Balance of Insurance Regulatory Charge Due
00
7.
Line 4 minus Lines 5 and 6, but not less than zero. If less than zero, enter amount on Line 10.
,
,
.
.
(See for current
8. a. Penalties
b. Interest
interest rate and penalty information)
00
00
,
,
,
.
$
00
9. Total Insurance Regulatory Charge Due
9.
(Add Lines 7, 8a and 8b)
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,
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.
00
10. Overpayment
10.
,
,
,
.
00
11. Amount of Line 10 to be Applied to 2013 Insurance Regulatory Charge
11.
,
,
,
.
12. Insurance Regulatory Charge to be Refunded
00
12.
Line 10 minus Line 11
(3) Additional Property
Schedule D. Installment Payments Made
(2) Insurance
(1) Gross Premium Tax
Coverage Tax
Regulatory Charge
(Do not include any negative amounts or amounts from Line 1 on Lines 2 - 4)
Prior Year Credit Applied to 2012
1.
(Gross Premium Tax - from prior IB-33, Sch. B, Part 3, Line 12)
(Insurance Regulatory Charge - from IB-33, Sch. C, Line 11)
(Add’l Property Coverage Tax - from IB-33, Sch. F, Line 21)
2. Installment Payment made April 15, 2012
(Gross Premium Tax - from IB-34, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-34, Part 2, Line 10)
(Add’l Property Coverage Tax - from IB-34, Part 3, Line 16)
3. Installment Payment made June 15, 2012
(Gross Premium Tax - from IB-34, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-34, Part 2, Line 10)
(Add’l Property Coverage Tax - from IB-34, Part 3, Line 16)
Installment Payment made October 15, 2012
4.
(Gross Premium Tax - from IB-34, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-34, Part 2, Line 10)
(Add’l Property Coverage Tax - from IB-34, Part 3, Line 16)
Total Installment Payments Made in 2012
5.
Add Lines 2 through 4
Schedule E. Guaranty Association Credit Available
Assessment Amount
Amount of Credit
Percentage
1. Assessment Year 2007
20%
Assessment Year 2008
20%
2.
Assessment Year 2009
20%
3.
Assessment Year 2010
20%
4.
Assessment Year 2011
20%
5.
Total

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