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

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207F ESA
First Installment
-
Organized Under Laws of
________________
Department of Revenue Services
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Foreign and Nonresident Insurance Companies
State of Connecticut
PO Box 2990 Hartford CT 06104-2990
(Rev. 5/05)
CT Insurance Premiums Tax Reg. No.
1
Enter 30% (.30) of the tax shown on 2004 Form 207F, Line 15
1
2
Enter amount from Schedule 1, Line 5 (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
5
Payment due with this coupon (Subtract Line 4 from Line 3)
5
Please change
Due Date:
March 15
name or
mailing
Make Checks Payable To:
address, or
Commissioner of Revenue Services
both,
Mail To:
Department of Revenue Services
if shown
Processing Section
incorrectly
PO Box 2990
at right
Hartford CT 06104-2990
207F ESB - Second Installment
Organized Under Laws of
________________
Department of Revenue Services
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Foreign and Nonresident Insurance Companies
State of Connecticut
PO Box 2990 Hartford CT 06104-2990
(Rev. 5/05)
CT Insurance Premiums Tax Reg. No.
1
Enter 60% (.60) of the tax shown on 2004 Form 207F, Line 15
1
2
Enter amount from Schedule 1, Line 5 (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
applied to estimated tax for current year
4
5
Payment due with this coupon (Subtract Line 4 from Line 3)
5
Please change
Due Date:
June 15
name or
mailing
Make Checks Payable To:
address, or
Commissioner of Revenue Services
both,
Mail To:
Department of Revenue Services
if shown
Processing Section
incorrectly
PO Box 2990
at right
Hartford CT 06104-2990
207F ESC - Third Installment
Organized Under Laws of
________________
Estimated Insurance Premiums Tax Payment Coupon
Department of Revenue Services
For Calendar Year Ending
Foreign and Nonresident Insurance Companies
State of Connecticut
PO Box 2990 Hartford CT 06104-2990
(Rev. 5/05)
CT Insurance Premiums Tax Reg. No.
1
Enter 80% (.80) of the tax shown on 2004 Form 207F, Line 15
1
2
Enter amount from Schedule 1, Line 5 (on back)
2
Date Received (DRS USE ONLY)
3
Enter the lesser of Line 1 or Line 2
3
Federal Employer ID Number
4
Enter amount paid with Forms 207F ESA and 207F ESB plus 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 change
Due Date:
September 15
name or
mailing
Make Checks Payable To:
address, or
Commissioner of Revenue Services
both,
Mail To:
Department of Revenue Services
if shown
Processing Section
incorrectly
PO Box 2990
at right
Hartford CT 06104-2990
207F ESD - Fourth Installment
Organized Under Laws of
_____________
Department of Revenue Services
Estimated Insurance Premiums Tax Payment Coupon
For Calendar Year Ending
Foreign and Nonresident Insurance Companies
State of Connecticut
PO Box 2990 Hartford CT 06104-2990
(Rev. 5/05)
CT Insurance Premiums Tax Reg. No.
1
Enter the tax shown on 2004 Form 207F, Line 15
1
2
Enter amount from Schedule 1, Line 5 (on back)
2
Date Received (DRS USE ONLY)
3
Enter the lesser of Line 1 or Line 2
3
Federal Employer ID Number
4
Enter amount paid with Forms 207F ESA, 207F ESB, and 207F ESC plus
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 change
Due Date:
December 15
name or
mailing
Make Checks Payable To:
address, or
Commissioner of Revenue Services
both,
Mail To:
Department of Revenue Services
if shown
Processing Section
incorrectly
PO Box 2990
at right
Hartford CT 06104-2990

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