Form 207 Est - Domestic Insurance Companies Tax, Hospital Service Corporations Tax And Medical Services Corporations Tax

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FOR CALENDAR YEAR ENDING
(Rev. 12/97)
CT TAX REGISTRATION NUMBER
1
Prior year tax
1
2
Multiply the estimated current year tax liability by 90% (.90)
2
DATE RECEIVED (DRS USE ONLY)
3
Required annual payment (Enter the lesser of Line 1 or Line 2)
3
FEDERAL EMPLOYER ID NUMBER
4
Amount paid with Forms 207 ESA, 207 ESB and 207 ESC plus overpayment
4
from prior year applied to estimated tax for current year
5
Payment due with this coupon (Subtract Line 4 from Line 3)
5
Please correct
DUE DATE:
December 15
name and
MAKE CHECKS PAYABLE TO:
mailing address
if shown
COMMISSIONER OF REVENUE SERVICES
incorrectly
MAIL TO:
Department of Revenue Services
at right
Processing Section
PO Box 2990
Hartford CT 06104-2990

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