Form 20-Ins - Oregon Insurance Excise Tax Return - 2012 Page 2
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1
2
3* 0 2 9 3 1 2 0 1 0 2 0 0 0 0 *
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Subtractions
15. Amortization of past service credits ..............................................
15
•
16. Increases in certain reserves.........................................................
16
•
17. Total other subtractions (from Schedule ASC-CORP ,
....
17
see instructions)
•
18. Total subtractions (add lines 15 through 17) ..................................................................................
18
19. Income before net loss deduction (line 14 minus line 18) .................................................................. 19
If income is derived from sources both in Oregon and other states, carry amount on line 19
to Schedule AP-2, line 1. Please complete both Schedules AP-1 and AP-2.
•
20. Net loss deduction (attach schedule) ............................................................................................
20
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21. Oregon taxable income (line 19 minus line 20, or amount from Schedule AP-2, line 11) ..............
21
22. Excise tax (6.6% or 7.6%; see instructions). .................................................................................... 22
•
23. Tax adjustment for interest on certain installment sales ................................................................
23
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24. Total tax (line 22 plus line 23) .........................................................................................................
24
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Credits
25. Total other credits (from Schedule ASC-CORP,
.....
25
see instructions)
•
26. Fire insurance gross premiums tax credit .....................................
26
•
27. OLHIGA (Oregon Life and Health Insurance Guaranty Association) offset ....................................
27
•
28. Total credits/offsets (add lines 25 through 27) ...............................................................................
28
•
29. Excise tax after credits and offsets (line 24 minus line 28) (not less than minimum tax) ..............
29
•
30. 2012 estimated tax payments from Schedule ES below. Include payments made with your extension ....
30
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31. Withholding payments made on your behalf from pass-through entity or real estate income ......
31
•
32. Tax due.
..........Tax due
32
Is line 29 more than line 30 plus line 31? If so, line 29 minus lines 30 and 31
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33. Overpayment.
... Overpayment
33
Is line 29 less than line 30 plus line 31? If so, line 30 plus line 31, minus line 29
34. Penalty due with this return ...............................................................34
35. Interest due with this return ...............................................................35
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36. Interest on underpayment of estimated tax (attach Form 37). .....
36
37. Total penalty and interest (add lines 34 through 36) .......................................................................... 37
38. Total due (line 32 plus line 37) ....................................................................................... Total due
38
39. Refund available (line 33 minus line 37) ............................................................................Refund
39
•
40. Amount of refund to be credited to 2013 estimated tax .............................................2013 Credit
40
41. Net refund (line 39 minus line 40)................................................................................ Net refund
41
Schedule ES—Estimated Tax Payments or Other Prepayments
Name of payer
Payer FEIN
Date of payment
Amount paid
/
/
1. 1st Quarter
1
/
/
2. 2nd Quarter
2
/
/
3. 3rd Quarter
3
/
/
4. 4th Quarter
4
5. Overpayment of last year’s tax elected as a credit against this year’s tax ............................................................... 5
/
/
6. Payments made with extension or other prepayments for this tax year and date paid ............
6
7. Claim of right credit (attach computation and explanation) ...................................................................................... 7
8. Total prepayments (carry to line 30 above) ............................................................................................................... 8
Under penalty of false swearing, I declare that the information in this return and any attachments is true, correct, and complete.
Sign
Signature of officer
Signature of preparer other than taxpayer
License number of preparer
Here
X
X
•
Date
Date
Telephone number
(
)
Print name of officer
Print name of preparer
Title of officer
Address of preparer
Attach Oregon schedules and file with the Oregon Department of Revenue
Mail refund returns and no tax due returns to: Mail tax-to-pay returns with payment and payment voucher to:
Refund, PO Box 14777, Salem OR 97309-0960
Oregon Department of Revenue, PO Box 14790, Salem OR 97309-0470
Form 20-INS, page 2 of 3
150-102-129 (Rev. 10-12)
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