Form M11t - Insurance Premium Tax Return And Firetown Report For Township Mutual - 2012

Download a blank fillable Form M11t - Insurance Premium Tax Return And Firetown Report For Township Mutual - 2012 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form M11t - Insurance Premium Tax Return And Firetown Report For Township Mutual - 2012 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

M11T
2012 Insurance Premium Tax Return and Firetown Report for
Township Mutual
Combined Report for Township Mutual Insurance Companies
Due March 1, 2013
Check if:
Amended return
No activity
Name of insurance company
FEIN
Minnesota tax ID (required)
Mailing address
NAIC number
State/country of incorporation
Check if new address
City
State
Zip code
Contact person
Daytime phone
Email address
Website address
Fax number
Date licensed in Minnesota
1 Gross direct premiums, including policy fees, premium finance and other charges
(from annual statement filed with the Minnesota Department of Commerce; attach a copy) . . . . . . . . 1
1%
2 Premium tax percentage rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Premium tax liability (multiply line 1 by line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Credit for historic structure rehabilitation
(attach credit certificate) and enter NPS project number: . . . . . . . . . . . .
. . 4
5 Tax liability (subtract line 4 from line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Premium tax prepayments
a Prior year‘s overpayment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a
b Estimated payment March 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b
c Estimated payment June 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6c
d Estimated payment Sept. 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6d
e Estimated payment Dec. 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6e
Total payments (add lines 6a through 6e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Tax due (or overpaid) (subtract line 6 from line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 a Additional charge for underpaying estimated tax
(determine from worksheet in the instructions) . . . . . . . . . . . . . . . . . 8a
b Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b
c Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c
Total (add lines 8a through 8c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 TOTAL AMOUNT DUE (or overpaid) (add lines 7 and 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
If you owe additional tax:
Payment method:
Electronic payment
Check
(payable to Minnesota Revenue; write MN tax ID number on check; attach Form PV42)
Enter amount paid
Date paid
(If amount paid is different from amount due on line 9, attach an explanation.)
If you overpaid:
Amount on line 9 to be credited to next year‘s estimated tax . . . . . . . . . . . . .
Amount on line 9 to be refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I declare that this return is correct and complete to the best of my knowledge and belief.
Authorized signature
Title
Date
Daytime phone
I authorize the Minnesota
Department of Revenue to
discuss this tax return with
Signature of preparer
Print name of preparer
Date
Daytime phone
the preparer.
Mail to: Minnesota Revenue, Mail Station 1780, St. Paul, MN 55145-1780

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 4