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RETALIATION GUIDE
January 2015 TO: Retaliatory Tax Guide Users FROM: Kara Binderup, Senior Counsel Patricia E. Cook, Paralegal III RE: State Forms State tax forms are generally available online, and this chart refers you to the website where you may view the forms. You may choose to insert the chart into Volume I of the Retaliation Guide. If you have any questions about the contents, you should ask the state contacts listed for each state. If you have a question about the printing and distribution of the copies, please contact the Insurance Products and Services Division at (816) 783-8300. The Retaliation Guide is intended to provide helpful information about retaliatory and other taxes and assessments. The Guide is not intended to be cited as binding legal authority and does not constitute a formal legal opinion by the NAIC staff on the provisions of state law and should not be relied upon as such. Every effort has been made to provide correct and accurate summaries to assist the reader in targeting useful information. For further details, including any additional adoptions, the statutes and regulations cited should be consulted.
Retaliation: A Guide to StateRetaliatory Taxes, Fees, Deposits
and Other Requirements
Volume II
January 2015
Accounting & ReportingInformation about statutory accounting principles and the procedures necessary for fi ling fi nancial annual statements and conducting risk-based capital calculations.
Consumer InformationImportant answers to common questions about auto, home, health and life insurance — as well as buyer’s guides on annuities, long-term care insurance and Medicare supplement plans.
Financial Regulation Useful handbooks, compliance guides and reports on fi nancial analysis, company licensing, state audit requirements and receiverships.
LegalComprehensive collection of NAIC model laws, regulations and guidelines; state laws on insurance topics; and other regulatory guidance on antifraud and consumer privacy.
Market RegulationRegulatory and industry guidance on market-related issues, including antifraud, product fi ling requirements, producer licensing and market analysis.
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For more information about NAIC publications, view our online catalog at:
http://store.naic.org
Special StudiesStudies, reports, handbooks and regulatory research conducted by NAIC members on a variety of insurance-related topics.
Statistical ReportsValuable and in-demand insurance industry-wide statistical data for various lines of business, including auto, home, health and life insurance.
Supplementary ProductsGuidance manuals, handbooks, surveys and research on a wide variety of issues.
Capital Markets & Investment AnalysisInformation regarding portfolio values and procedures for complying with NAIC reporting requirements.
White Papers Relevant studies, guidance and NAIC policy positions on a variety of insurance topics.
© 1991-2015 National Association of Insurance Commissioners. All rights reserved.
ISBN: 978-1-59917-806-6
Printed in the United States of America
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any storage or retrieval system, without written permission from the NAIC.
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The NAIC is the authoritative source for insurance industry information. Our expert solutions support the efforts of regulators, insurers and researchers by providing detailed and comprehensive insurance information. The NAIC offers a wide range of publications in the following categories:
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
1
AL
AB
AM
A
Web
site
: w
ww
.ald
oi.g
ov
C
onta
cts:
A
nn S
tric
klan
d (3
34)
241-
4154
an
n.st
rick
land
@in
sura
nce.
alab
ama.
gov
In
stru
ctio
ns:
C
ompa
nies
hav
e th
e op
tion
of s
ubm
ittin
g th
eir
tax
retu
rns
in h
ard
copy
an
d m
akin
g pa
ymen
t by
chec
k or
sub
mit
ting
thei
r ta
x re
turn
s an
d E
FT
paym
ent t
hrou
gh th
e N
AIC
OP
Tin
s pro
gram
. Com
pani
es f
iling
in h
ard
copy
may
obt
ain
the
form
s fr
om o
ur w
ebsi
te b
y cl
icki
ng F
orm
s on
the
drop
dow
n un
der
Com
pani
es.
B
elin
da W
illia
ms
(334
) 24
1-41
62
beli
nda.
wil
liam
s@in
sura
nce.
alab
ama.
gov
T
odri
ck B
urks
(33
4) 2
41-4
163
todr
ick.
burk
s@in
sura
nce.
alab
ama.
gov
AL
ASK
A
Web
site
:
Ala
ska
pref
ers
the
form
s an
d pa
ymen
ts b
e fi
led
and
paid
thro
ugh
OPT
ins.
Or
com
pani
es c
an a
cces
s th
e ha
rd c
opy
on th
e w
eb a
t:
ww
w.in
sura
nce.
alas
ka.g
ov (
then
cli
ck o
n C
ompa
nies
then
Inf
orm
atio
n fo
r C
ompa
nies
, the
n A
nnua
l Fili
ng a
nd P
rem
ium
Tax
For
ms
then
cho
se th
e co
mpa
ny’s
org
aniz
atio
n ty
pe to
get
to th
e ta
x fo
rms)
.
Con
tact
s:
Reb
ecca
Nes
heim
(90
7) 4
65-2
584
re
becc
a.ne
shei
m@
alas
ka.g
ov
Inst
ruct
ion
s:
All
form
s ar
e av
aila
ble
in A
dobe
, as
filla
ble,
as
wel
l as
Exc
el, w
ith a
ll th
e ca
lcul
atio
ns p
rovi
ded.
Ins
truc
tions
are
pos
ted
at th
e be
ginn
ing
of e
very
ta
x fo
rm.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
2
AR
IZO
NA
W
ebsi
te:
ww
w.a
zins
uran
ce.g
ov/
Con
tact
s:
Sus
an Y
epez
(60
2) 3
64-3
997
syep
ez@
azin
sura
nce.
gov
Inst
ruct
ion
s:
To
loca
te f
orm
s, c
lick
on
“Ins
urer
s” a
nd s
elec
t “T
axes
”. O
nly
use
curr
ent
form
s –
even
whe
n am
endi
ng p
rior
-yea
r ta
x re
port
s. T
o pa
y ta
xes
or f
ees
elec
tron
ical
ly, y
ou m
ust u
se th
e N
AIC
OP
Tin
s sys
tem
. To
pay
by c
heck
, m
ake
your
pay
men
t to
“Ari
zona
Ins
uran
ce T
ax U
nit,”
incl
ude
your
NA
IC
num
ber
in th
e m
emo
sect
ion
of th
e ch
eck/
stub
, and
sen
d it
with
req
uire
d do
cum
ents
to th
e ad
dres
s at
the
top
of th
e ta
x/fe
es r
epor
t SE
PA
RA
TE
fr
om (
not i
n th
e sa
me
enve
lope
as)
ann
ual o
r qu
arte
rly
stat
emen
ts, a
nd
sepa
rate
fro
m ta
x in
stal
lmen
ts y
ou m
ay o
we
for
the
curr
ent y
ear.
If
you
are
dom
icile
d in
Ala
ska,
Cal
ifor
nia
(tax
liab
ility
of
$20,
000
or
mor
e), C
olor
ado
or G
eorg
ia, y
ou m
ust
use
Opt
ins t
o fi
le y
our
tax/
reta
liatio
n re
port
s.
M
ary
Jord
an (
602)
364
-310
0 M
jord
an@
azin
sura
nce.
gov
AR
KA
NSA
S W
ebsi
te:
ww
w.in
sura
nce.
arka
nsas
.gov
Con
tact
s:
Acc
ount
ing
Div
isio
n (5
01)
371-
2605
in
sura
nce.
acco
untin
g@ar
kans
as.g
ov
Inst
ruct
ion
s:
To
loca
te f
orm
s, s
elec
t and
clic
k on
Acc
ount
ing
(loc
ated
und
er D
ivis
ions
) an
d cl
ick
on ‘
For
eign
& D
omes
tic I
nsur
ers
Qua
rter
ly &
Ann
ual P
rem
ium
T
ax, A
nnua
l Con
tinu
atio
n F
ees,
& A
cces
s to
fil
e by
EF
T’.
Nex
t scr
oll t
o th
e bo
ttom
of
the
page
and
clic
k on
eit
her
Ann
ual o
r Q
uart
erly
by
chec
k to
fin
d ha
rd c
opy
of f
orm
s. I
f fi
ling
by E
FT c
lick
on li
ne f
or E
FT
.
CA
LIF
OR
NIA
W
ebsi
te:
http
://w
ww
.insu
ranc
e.ca
.gov
Con
tact
s:
Pre
miu
mta
xaud
it@
insu
ranc
e.ca
.gov
Web
site
: ht
tp://
ww
w.in
sura
nce.
ca.g
ov/0
250-
insu
rers
/030
0-in
sure
rs/0
100-
appl
icat
ions
/tax-
form
s-in
stru
ct-a
nd-i
nfo/
inde
x.cf
m
Inst
ruct
ion
s:
Und
er I
nsur
ers,
clic
k on
“In
sure
rs”.
Nex
t clic
k on
“A
pplic
atio
ns, F
orm
s &
F
iling
s”. C
lick
on “
Tax
For
ms,
Ins
truc
tions
, & I
nfor
mat
ion”
, the
n se
lect
“2
014
Tax
For
ms,
Ins
truc
tions
and
Inf
orm
atio
n” to
acc
ess
the
appr
opri
ate
form
s.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
3
CO
LO
RA
DO
W
ebsi
te:
http
s://w
ww
.dor
a.st
ate.
co.u
s/pl
s/re
al/o
pt.lo
gon
C
onta
cts:
R
egin
a F
ord
(303
) 89
4-75
44
regi
na.f
ord@
stat
e.co
.us
Web
site
: T
he D
ivis
ion
of I
nsur
ance
is a
ccep
ting
onl
y el
ectr
onic
fil
ing
of p
rem
ium
ta
xes.
For
que
stio
ns, p
leas
e go
to w
ww
.dor
a.co
lora
do.g
ov/D
OI.
Inst
ruct
ion
s:
CO
NN
EC
TIC
UT
W
ebsi
te:
ww
w.c
t.gov
/DR
S
C
onta
cts:
B
arba
ra C
olli
ns
(Dep
t. of
Rev
enue
Ser
vice
s)
(860
) 54
1-32
25
Inst
ruct
ion
s:
Cli
ck o
n F
orm
s, th
en B
usin
esse
s. G
o to
Pub
lic S
ervi
ce T
ax F
orm
s, c
lick
on
Cur
rent
Yea
r, th
en c
lick
on
Insu
ranc
e/H
ealt
h C
are.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
4
DE
LA
WA
RE
W
ebsi
te:
http
://w
ww
.del
awar
eins
uran
ce.g
ov
C
onta
cts:
D
OI_
TA
X@
stat
e.de
.us
Inst
ruct
ion
s:
The
Del
awar
e In
sura
nce
Dep
artm
ent h
as p
artn
ered
with
the
NA
IC in
the
use
of O
PT
ins f
or O
nlin
e P
rem
ium
Tax
fili
ng. T
he D
epar
tmen
t en
cour
ages
all
com
pani
es -
incl
udin
g ta
x ex
empt
com
pani
es th
at p
ay
annu
al r
enew
al f
ees
- to
use
OP
Tin
s to
elec
tron
ical
ly s
ubm
it D
elaw
are
prem
ium
tax
and
annu
al r
enew
al f
orm
s an
d pa
ymen
ts. O
PT
ins i
s th
e pr
efer
red
met
hod
for
subm
ittin
g ca
lend
ar y
ear
2014
ann
ual p
rem
ium
tax
and
fees
. How
ever
, OP
Tin
s is
not m
anda
tory
at t
his
tim
e.
Com
pani
es th
at a
re u
nabl
e to
use
OP
Tin
s at t
his
tim
e ca
n fi
nd ta
x an
d an
nual
ren
ewal
for
ms
by f
ollo
win
g th
ese
inst
ruct
ions
. Und
er I
nfor
mat
ion
for
Bus
ines
s, c
lick
on P
rem
ium
Tax
es a
nd F
ees
(all
com
pani
es in
clud
ing
AR
, SL
, PG
, and
RR
G).
Cho
ose
the
nece
ssar
y fo
rm b
ased
on
com
pany
ty
pe. N
OT
E: A
ll p
rem
ium
tax
and
fees
rep
ortin
g fo
rms
are
avai
labl
e vi
a th
e w
ebsi
te. T
he D
epar
tmen
t no
long
er m
ails
for
ms
to a
ny c
ompa
nies
un
less
a s
peci
fic
requ
est f
or f
orm
s is
rec
eive
d.
D
anie
lle W
atso
n (3
02)
674-
7344
da
niel
le.w
atso
n@st
ate.
de.u
s A
nn F
letc
her
(302
) 67
4-73
83
ann.
flet
cher
@st
ate.
de.u
s
DIS
TR
ICT
of
CO
LU
MB
IA
Web
site
: ht
tp://
disb
.dc.
gov/
node
/325
132
C
onta
cts:
Je
ssie
Li
(202
) 44
2-85
68 o
r 72
7-80
00
jess
ie.li
@dc
.gov
Inst
ruct
ion
s:
The
D.C
. Dep
artm
ent o
f In
sura
nce,
Sec
uriti
es a
nd B
anki
ng e
ncou
rage
s al
l D
.C. l
icen
sed
insu
rers
file
pre
miu
m ta
x re
turn
s th
roug
h N
AIC
OPT
ins.
The
abo
ve li
nk p
rovi
des
dire
ct a
cces
s to
the
D.C
. 201
4 pr
emiu
m ta
x fo
rms
and
fili
ng in
stru
ctio
ns.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
5
FL
OR
IDA
W
ebsi
te:
http
://m
yflo
rida
.com
/dor
/
Con
tact
s:
Deb
ra G
iffo
rd, C
PA
(D
ept.
of R
ev.)
(8
50)
717-
6752
G
iffo
rdD
@do
r.st
ate.
fl.u
s
Inst
ruct
ion
s:
To
acce
ss th
e m
ost r
ecen
t ins
uran
ce p
rem
ium
tax
form
s, u
nder
‘Q
uick
L
inks
’, c
lick
on ‘
For
ms
and
Publ
icat
ions
’. S
crol
l dow
n to
‘In
sura
nce
Pre
miu
m T
ax’.
The
FL
insu
ranc
e pr
emiu
m ta
x fo
rm is
for
m n
umbe
r D
R-
908.
Ins
truc
tions
are
list
ed a
s fo
rm n
umbe
r D
R-9
08N
.
GE
OR
GIA
W
ebsi
te:
ww
w.o
ci.g
a.go
v
Con
tact
s:
Lin
da B
rook
s (P
rem
ium
Tax
Iss
ues)
(4
04)
656-
7553
L
Bro
oks@
oci.g
a.go
v In
stru
ctio
ns:
C
lick
on P
rem
ium
Tax
.
Web
site
for
GA
F
iref
igh
ters
’ P
ensi
on
Fu
nd:
ww
w.g
fpf.
org
Mor
gan
Wur
st
(GA
Fir
efig
hter
’s P
ensi
on F
und)
(7
70)
388-
5757
m
orga
n@gf
pf.o
rg
Inst
ruct
ion
s:
Tax
for
m f
or th
e F
iref
ight
ers’
insu
ranc
e pr
emiu
m ta
x is
ava
ilab
le f
or
dow
nloa
ding
. Fro
m th
e H
ome
Pag
e, c
lick
on
’Fun
d F
orm
s’, t
hen
from
the
drop
dow
n lis
t, se
lect
‘In
sura
nce
Com
pani
es’,
then
, scr
oll d
own
and
sele
ct
the
curr
ent y
ear’
s in
sura
nce
prem
ium
tax
form
for
dow
nloa
ding
fro
m th
e si
te.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
6
GU
AM
W
ebsi
te:
http
s://
ww
w.g
uam
tax.
com
/for
ms/
Con
tact
s:
Law
renc
e S
. Ter
laje
, Sup
ervi
sor
(6
71)
635-
1842
lte
rlaj
e@re
vtax
.gua
m.g
ov
Inst
ruct
ion
s:
HA
WA
II
Web
site
: ht
tp:/
/cca
.haw
aii.g
ov/i
ns/i
nsur
ers/
annu
al-f
ilin
g-in
stru
ctio
ns-a
nd-t
ax-f
orm
s
Con
tact
s:
Gal
e M
iyaz
aki
(808
) 58
7-67
41
Inst
ruct
ion
s:
To
loca
te f
orm
s, u
nder
‘T
ax a
nd O
ther
For
ms’
sel
ect a
nd c
lick
on
For
ms
314,
323
, 322
and
315
Web
site
: ht
tp:/
/cca
.haw
aii.g
ov/i
ns/s
urpl
us-l
ines
-tax
/
Mar
gare
t Wan
(S
urpl
us L
ines
) (8
08)
586-
8151
In
stru
ctio
ns:
F
orm
104
– N
RR
A Q
uart
erly
Tax
For
ms
for
Sur
plus
Lin
es B
roke
rs, a
nd
for
Inde
pend
ently
Pro
cure
d.
Web
site
: ht
tp:/
/cca
.haw
aii.g
ov/i
ns/o
ther
_ins
/ris
k_re
tent
ion_
grou
ps_f
orei
gn/
G
ale
Miy
azak
i (F
orei
gn R
RG
s)
(808
) 58
7-67
41
Inst
ruct
ion
s:
For
m R
RG
(12
-13)
HI
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
7
IDA
HO
W
ebsi
te:
ww
w.d
oi.id
aho.
gov
C
onta
cts:
K
athy
Mill
er (
Tax
Sup
ervi
sor)
(2
08)
334-
4282
K
athy
.mil
ler@
doi.i
daho
.gov
Inst
ruct
ion
s:
Clic
k on
Com
pani
es, s
elec
t Tax
and
Con
tinua
tion
Fee
Fili
ngs
from
list
ing,
cl
ick
on th
e al
phab
etic
ally
lice
nsed
, lis
ted
or o
ther
wis
e ap
prov
ed e
ntiti
es
to lo
cate
the
Pre
miu
m T
ax a
nd F
ee S
tate
men
ts/I
nstr
uctio
ns li
nk.
Idah
o en
cour
ages
com
pani
es to
fil
e el
ectr
onic
ally
wit
h O
PT
Ins t
he A
nnua
l P
rem
ium
Tax
or
Con
tinua
tion
Fee
Sta
tem
ent.
Con
tact
op
tinsm
ktg@
naic
.org
to r
egis
ter.
ILL
INO
IS
Web
site
: w
ww
.insu
ranc
e.il
lino
is.g
ov
C
onta
cts:
R
ob H
aven
s (2
17)
782-
0055
D
oug
Hol
lis
(217
) 78
2-00
55
Inst
ruct
ion
s:
Und
er ’
Com
pani
es’,
clic
k on
‘T
ax F
orm
s’.
For
the
Illin
ois
Mun
icip
al L
eagu
e F
ire
Tax
fun
d, d
ue b
y th
e en
d of
Aug
ust
– as
of
2011
, ele
ctro
nic
filin
g on
ly: h
ttp://
fire
tax.
iml.o
rg
R
oger
Hue
bner
(I
L M
unic
ipal
ity
& F
ire
Pro
tect
ion
Dis
t. F
orei
gn F
ire
Ins.
Co.
Fir
e T
ax)
(217
) 52
5-12
20
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
8
IND
IAN
A
Web
site
: ht
tp://
ww
w.in
.gov
/idoi
/232
8.ht
m
OP
Tin
s web
site
: http
://w
ww
.opt
ins.
org
Con
tact
s:
Deb
ra G
rave
s
(317
) 23
2-19
93
dgra
ves@
idoi
.IN
.gov
Inst
ruct
ion
s:
The
Ind
iana
Dep
artm
ent o
f In
sura
nce
(ID
OI)
has
par
tner
ed w
ith th
e N
atio
nal A
ssoc
iatio
n of
Ins
uran
ce C
omm
issi
oner
s (N
AIC
) in
the
use
of
OP
Tin
s, an
onl
ine
prem
ium
tax
filin
g sy
stem
. OP
Tin
s off
ers
insu
ranc
e co
mpa
nies
the
abili
ty to
sub
mit
thei
r qu
arte
rly
and
annu
al p
rem
ium
tax
fili
ngs,
ann
ual r
enew
al f
ees
and
paym
ents
ele
ctro
nica
lly.
In
sura
nce
com
pani
es a
re n
ot r
equi
red
to u
se O
PT
ins,
but O
PT
ins i
s th
e pr
efer
red
met
hod
for
subm
ittin
g ca
lend
ar y
ear
2014
ann
ual p
rem
ium
taxe
s an
d fe
es. B
egin
ning
with
the
2015
qua
rter
ly e
stim
ated
pre
miu
m ta
x fi
lings
in
sura
nce
com
pani
es w
ill b
e re
quir
ed to
file
ele
ctro
nica
lly u
tiliz
ing
the
NA
IC O
PT
ins s
yste
m.
Insu
ranc
e co
mpa
nies
will
nee
d to
con
tact
the
OP
Tin
s Mar
keti
ng T
eam
at
optin
smkt
g@na
ic.o
rg o
r ca
ll (8
16)
783-
8787
to s
etup
an
OP
Tin
s acc
ount
.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
9
IOW
A
Web
site
: w
ww
.iid.
stat
e.ia
.us/
prem
tax
Con
tact
s:
Don
na F
lam
m
(515
) 24
2-51
78; F
ax: (
515)
281
-305
9 pr
emiu
m.ta
x@iid
.iow
a.go
v
Inst
ruct
ion
s:
Oth
er th
an L
ife
form
s ar
e pr
efer
red
on y
ello
w p
aper
. L
ife
and
Fra
tern
al f
orm
s ar
e pr
efer
red
on b
lue
pape
r.
KA
NSA
S W
ebsi
te:
http
://w
ww
.ksi
nsur
ance
.org
Con
tact
s:
Joyc
e B
anks
(7
85)
291-
3191
JR
Ban
ks@
ksin
sura
nce.
org
Inst
ruct
ion
s:
The
Kan
sas
Insu
ranc
e D
epar
tmen
t pro
vide
s fo
r an
d re
quir
es th
at
com
pani
es u
se th
e D
epar
tmen
t’s
pers
onal
ized
tax
form
s. U
sing
the
abov
e w
eb a
ddre
ss, a
com
pany
rep
rese
ntat
ive
can
sele
ct th
e “A
gent
/Com
pany
S
ervi
ces”
tab
loca
ted
near
the
top
righ
t-ha
nd s
ide
of th
e pa
ge. S
elec
t “C
ompa
ny D
eskt
op”.
At t
his
poin
t, th
e co
mpa
ny r
epre
sent
ativ
e w
ill n
eed
to e
nter
use
r id
entif
icat
ion
and
pass
wor
d in
form
atio
n to
acc
ess
the
pers
onal
ized
for
m. I
nstr
ucti
ons
are
prov
ided
on
the
sam
e pa
ge, f
or
obta
inin
g si
gn-o
n in
form
atio
n.
Gen
eral
info
rmat
ion
for
fili
ng th
e 20
14 ta
x re
turn
s, a
long
with
sam
ple
tax
form
s, c
an b
e fo
und
at
http
://w
ww
.ksi
nsur
ance
.org
/indu
stry
/com
pany
/taxf
orm
s.ht
m.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
10
KE
NT
UC
KY
W
ebsi
te:
ww
w.r
even
ue.k
y.go
v
Con
tact
s:
Che
ryl H
unt
(Dep
t. of
Rev
.)
(502
) 56
4-48
10
cher
yl.h
unt@
ky.g
ov
Inst
ruct
ion
s:
Whe
n us
ing
ww
w.r
even
ue.k
y.go
v, c
lick
on ‘
Tax
For
ms’
(le
ft h
and
side
),
then
‘C
urre
nt Y
ear
Form
s’, t
hen
scro
ll do
wn
to ‘
Insu
ranc
e P
rem
ium
s T
ax/S
urch
arge
’.
S
haun
Orm
e, G
en. C
ouns
el
(Ofc
. of
Ins.
Leg
al D
iv.)
(5
02)
564-
6032
S
haun
T.O
rme@
ky.g
ov
Josh
Ray
born
(C
onsu
mer
Pro
tect
ion
Div
.)
(502
) 56
4-60
32
Josh
.Ray
born
@ky
.gov
Web
site
: ht
tp://
insu
ranc
e.ky
.gov
Inst
ruct
ion
s:
Loc
al G
over
nmen
t Pre
miu
m T
ax m
ust b
e fi
led
elec
tron
ical
ly. U
nder
H
ome
on th
e ho
me
page
cho
ose
Div
isio
ns a
nd P
rogr
ams.
Fro
m th
e dr
op
dow
n lis
ting
choo
se L
ocal
Gov
ernm
ent P
rem
ium
Tax
. Und
er H
ome
on th
e ne
xt p
age
choo
se F
orm
s an
d D
ocum
ents
. For
ms
are
loca
ted
in th
e th
ird
bloc
k of
info
rmat
ion
alon
g w
ith o
ther
Pre
miu
m ta
x in
form
atio
n. L
GP
T
140,
141
and
142
alo
ng w
ith th
e in
stru
ctio
ns.
LO
UIS
IAN
A
Web
site
: w
ww
.ldi.s
tate
.la.u
s ht
tp:/
/ww
w.ld
i.sta
te.la
.us/
indu
stry
/tax
es-a
nd-a
sses
smen
ts/a
dmit
ted-
prem
ium
-tax
ht
tp://
ww
w.ld
i.sta
te.la
.us/
indu
stry
/taxe
s-an
d-as
sess
men
ts/s
urpl
us-l
ines
-pr
emiu
m-t
ax
Con
tact
s:
Tom
my
Coc
o (2
25)
342-
1012
tc
oco@
ldi.s
tate
.la.u
s
Inst
ruct
ion
s:
Und
er “
Indu
stry
” cl
ick
on “
Tax
es a
nd A
sses
smen
ts”.
The
dro
p do
wn
men
u ha
s lin
ks to
bot
h Su
rplu
s L
ines
tax
form
s an
d A
dmit
ted
tax
form
s.
The
Adm
itte
d F
orm
106
1 an
d F
orm
107
6 m
ust
be
file
d el
ectr
onic
ally
th
roug
h th
e In
dust
ry A
cces
s lin
k. T
he S
urpl
us L
ine
form
126
5 ca
n al
so b
e fi
led
elec
tron
ical
ly.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
11
MA
INE
W
ebsi
te:
http
://w
ww
.mai
ne.g
ov/r
even
ue/f
orm
s/in
sura
nce/
2013
.htm
Con
tact
s:
Ken
dra
Coa
tes
(207
) 62
4-84
95
Ken
dra.
L.C
oate
s@m
aine
.gov
In
stru
ctio
ns:
MA
RY
LA
ND
W
ebsi
te:
http
://w
ww
.mdi
nsur
ance
.sta
te.m
d.us
/sa/
prem
ium
-tax
/inde
x.ht
ml
Con
tact
s:
Chr
isto
pher
Buc
hana
n (4
10)
468-
2122
ch
rist
ophe
r.bu
chan
an@
mar
ylan
d.go
v
Inst
ruct
ion
s:
MA
SS
AC
HU
SE
TT
S
Web
site
: ht
tp://
ww
w.m
ass.
gov/
dor/
form
s/
C
onta
cts:
T
odd
Sha
rek
(Dep
t. of
Rev
enue
)
(617
) 88
7-51
01
shar
ek@
dor.
stat
e.m
a.us
Inst
ruct
ion
s:
On
the
left
han
d si
de o
f th
e sc
reen
, sel
ect “
Fin
anci
al I
nsti
tutio
n an
d In
sura
nce
Com
pany
For
ms”
. Sel
ect t
he a
ppro
pria
te y
ear.
Ele
ctro
nic
filin
g is
not
ava
ilabl
e at
this
tim
e. A
ny b
alan
ce d
ues
can
be p
aid
with
a c
heck
pa
yabl
e to
“C
omm
onw
ealth
of
MA
” at
tach
ed to
the
retu
rn.
R
ober
t Mac
ulla
r (F
inan
cial
Sur
veill
ance
) (6
17)
521-
7398
ro
bert
.mac
ulla
r@st
ate.
ma.
us
T
o ob
tain
a W
orke
rs’
Com
pens
atio
n S
ched
ule
C-1
, go
to
http
://w
ww
.mas
s.go
v/oc
abr/
docs
/doi
/com
pani
es/f
orm
s/fo
rmc1
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
12
MIC
HIG
AN
B
usi
nes
s T
axes
F
orm
s &
In
stru
ctio
ns:
M
BT
: ht
tp://
ww
w.m
ichi
gan.
gov/
taxe
s/0,
1607
,7-2
38-4
6621
_473
62--
-,0
0.ht
ml
CIT
: http
://w
ww
.mic
higa
n.go
v/ta
xes/
0,46
76,7
-238
-595
53--
-,00
.htm
l F
TW
: ht
tp://
ww
w.m
ichi
gan.
gov/
taxe
s/0,
4676
,7-2
38-
4351
9_43
521_
4403
9-31
8037
--,0
0.ht
ml
Con
tact
s:
Jenn
i Har
ding
– B
usin
ess
Tax
es
(517
) 37
3-96
00
Har
ding
J2@
mic
higa
n.go
v
Oth
er S
tate
Tax
For
ms
&
Inst
ruct
ion
s:
Mic
higa
n re
quir
es e
lect
roni
c fi
ling
thro
ugh
NA
IC O
PT
ins w
ith th
e ex
cept
ion
of e
xem
pt c
omm
erci
al p
olic
yhol
ders
(E
CP
). A
ll M
ichi
gan
form
s ar
e av
aila
ble
on th
e O
PT
ins w
ebsi
te. E
CP
may
use
OP
Tin
s or
Mic
higa
n D
IFS
pap
er f
orm
(F
IS 0
255)
ava
ilab
le o
n M
ichi
gan
DIF
S
web
site
ww
w.m
ichi
gan.
gov/
difs
.
M
ary
Kru
g –
Surp
lus
Lin
es T
axes
onl
y (5
17)
241-
4529
kr
ugm
@m
ichi
gan.
gov
MIN
NE
SOT
A
Web
site
: w
ww
.rev
enue
.sta
te.m
n.us
Con
tact
s:
Jerr
y S
ieve
(M
N R
even
ue)
(651
) 55
6-30
24 o
r (6
51)
556-
4729
je
rry.
siev
e@st
ate.
mn.
us
In
stru
ctio
ns:
U
nder
Bus
ines
ses,
clic
k on
“A
ll B
usin
ess
Tax
es”,
clic
k on
“In
sura
nce
Tax
es &
Sur
char
ges”
.
MIS
SIS
SIP
PI
Web
site
: w
ww
.dor
.ms.
gov/
Con
tact
s:
Der
rick
Bar
nes
(601
) 92
3-70
83
Der
rick
.bar
nes@
dor.
ms.
gov
In
stru
ctio
ns:
U
nder
“B
usin
ess”
, clic
k on
“O
ther
taxe
s,”
then
cli
ck “
Insu
ranc
e P
rem
ium
.”
B
arba
ra M
ayes
(M
S D
ept.
of R
even
ue)
(602
) 92
3-71
83
Bar
bara
.may
es@
dor.
ms.
gov
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
13
MIS
SOU
RI
Web
site
: ht
tp:/
/ins
uran
ce.m
o.go
v/in
dust
ry/f
orm
s
Con
tact
s:
Tam
my
Pol
lrei
sz
(573
) 75
1-19
29
Tam
my.
Pol
lrei
sz@
insu
ranc
e.m
o.go
v
Inst
ruct
ion
s:
2014
Pro
pert
y &
Cas
ualty
Ins
uran
ce C
ompa
ny P
rem
ium
Tax
Ret
urn:
ht
tp://
insu
ranc
e.m
o.go
v/in
dust
ry/f
orm
s/37
5-04
09-1
5.pd
f
Nol
and
Stu
ecke
n (5
73)
526-
4986
N
olan
d.S
tuec
ken@
insu
ranc
e.m
o.go
v
20
14 L
ife
& H
ealth
Ins
uran
ce C
ompa
ny P
rem
ium
Tax
Ret
urn:
ht
tp://
insu
ranc
e.m
o.go
v/in
dust
ry/f
orm
s/37
5-04
11-1
5.pd
f
20
14 C
hpt.
380
Mut
ual I
nsur
ance
Com
pany
Pre
miu
m T
ax R
etur
n:
http
://in
sura
nce.
mo.
gov/
indu
stry
/for
ms/
375-
0429
-15.
20
15 Q
uart
erly
Adm
inis
trat
ive
Rep
ort F
orm
: ht
tp://
insu
ranc
e.m
o.go
v/in
dust
ry/f
orm
s/do
cum
ents
/375
-070
1-20
15.p
df
MO
NT
AN
A
Web
site
: w
ww
.csi
.mt.g
ov
C
onta
cts:
R
usse
ll E
hman
(E
xam
inat
ions
Bur
eau)
(4
06)
444-
4350
re
hman
@m
t.gov
Inst
ruct
ion
s:
For
ms
are
unde
r “A
nnua
l Ren
ewal
s, F
iling
s &
Tax
Inf
orm
atio
n”.
NE
BR
AS
KA
W
ebsi
te:
ww
w.d
oi.n
ebra
ska.
gov
C
onta
cts:
M
arth
a H
ette
nbau
gh
(402
) 47
1-46
71
mar
tha.
hette
nbau
gh@
nebr
aska
.gov
Inst
ruct
ion
s:
Und
er C
ompa
ny h
eadi
ng c
lick
on
‘Mor
e In
fo f
or C
ompa
nies
…’
and
then
P
rem
ium
Tax
For
ms.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
14
NE
VA
DA
W
ebsi
te:
http
://ta
x.nv
.gov
Con
tact
s:
Nic
ky B
aily
(D
ept.
of T
axat
ion)
(7
75)
684-
2123
nb
aily
@ta
x.st
ate.
nv.u
s
Inst
ruct
ion
s:
Und
er ‘
Tax
For
ms’
sel
ect ‘
Exc
ise
Tax
For
ms’
then
‘In
sura
nce
Prem
ium
T
ax’.
Cho
ose
from
Qua
rter
ly P
rem
ium
, Qua
rter
ly I
ndus
tria
l, A
nnua
l P
rem
ium
, Ann
ual I
ndus
tria
l and
Ind
epen
dent
ly P
rocu
red
Insu
ranc
e R
etur
ns.
NE
W H
AM
PS
HIR
E
Web
site
: ht
tp://
ww
w.n
h.go
v/in
sura
nce/
com
pani
es/p
rem
ium
tax/
inde
x.ht
m
C
onta
cts:
N
orm
a S
tall
ings
(6
03)
271-
7973
x 9
-275
N
orm
a.st
allin
gs@
ins.
nh.g
ov
Inst
ruct
ion
s:
NE
W J
ER
SE
Y
Web
site
: w
ww
.sta
te.n
j.us/
trea
sury
/tax
atio
n;
or, h
ttp:
//w
ww
.sta
te.n
j.us/
trea
sury
/taxa
tion/
prnt
ins.
shtm
l
Con
tact
s:
Tan
veer
Ahm
ed
(609
) 29
2-72
72 e
xt. 5
0413
ta
nvee
r.ah
med
@do
bi.s
tate
.nj.u
s In
stru
ctio
ns:
C
lick
on F
orm
s. C
lick
on “
Prin
t/Dow
nloa
d T
ax F
orm
s.”
Scr
oll d
own
to
clic
k on
“In
sura
nce
Pre
miu
ms
Tax
.”
NE
W M
EX
ICO
W
ebsi
te:
ww
w.o
si.s
tate
.nm
.us
C
onta
cts:
S
haw
na M
aest
as
(505
) 82
7-40
75
shaw
na.m
aest
as@
stat
e.nm
.us
Inst
ruct
ion
s:
Cli
ck o
n “I
nsur
ance
Bur
eaus
” at
the
top
of th
e pa
ge, t
hen
clic
k “F
inan
cial
A
udit
Bur
eau/
Pre
miu
m T
ax”
and
then
“P
rem
ium
Tax
” to
loca
te “
For
ms
&
Info
rmat
ion”
. D
epar
tmen
t’s
curr
ent p
olic
y is
not
to c
olle
ct r
etal
iato
ry ta
xes,
see
B
ulle
tin 2
009-
008
(Jul
y 9,
200
9).
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
15
NE
W Y
OR
K
Web
site
: w
ww
.tax.
ny.g
ov
C
onta
cts:
S
uzan
ne T
enny
son
(518
) 38
9-49
13
Suz
anne
.Ten
nyso
n@ta
x.ny
.gov
In
stru
ctio
ns:
In
the
mid
dle
of th
e m
ain
page
und
er “
Popu
lar
Top
ics”
, clic
k on
“Fo
rms
and
inst
ruct
ions
.” C
lick
on “
Cor
pora
tion
tax”
then
sel
ect a
nd c
lick
on “
Insu
ranc
e co
rpor
atio
ns”.
T
he ta
x re
turn
for
a n
on-l
ife
com
pany
is f
orm
CT
-33-
NL
, the
inst
ruct
ions
ar
e C
T-3
3-N
L-I
; the
tax
retu
rn f
or li
fe c
ompa
ny is
for
m C
T-3
3, th
e in
stru
ctio
ns a
re C
T-3
3-I;
and
the
MT
A f
orm
is C
T-3
3-M
.
NO
RT
H C
AR
OL
INA
W
ebsi
te:
ww
w.d
ornc
.com
/for
ms/
Con
tact
s:
Chr
is L
ong
(Dep
t. of
Rev
.)
(919
) 75
4-26
00
Chr
is.L
ong@
dorn
c.co
m
Inst
ruct
ion
s:
Clic
k on
“In
sura
nce”
. Thi
s w
ill ta
ke y
ou to
the
2014
tax
form
s. B
egin
ning
w
ith ta
x ye
ar 2
010,
Sel
f In
sure
d W
orke
rs’
Com
pens
atio
n C
orpo
ratio
n re
turn
s w
ere
avai
labl
e vi
a th
e ab
ove
web
site
.
NO
RT
H D
AK
OT
A
Web
site
: w
ww
.nd.
gov/
ndin
s/
C
onta
cts:
Jo
n D
atsk
o (7
01)
328-
2440
jd
atsk
o@nd
.gov
pr
emiu
mta
x@nd
.gov
In
stru
ctio
ns:
C
hoos
e C
ompa
nies
, the
n F
inan
cial
Rep
ortin
g an
d T
ax R
equi
rem
ents
, the
n P
rem
ium
Tax
Fil
ing.
Lin
ks to
for
ms
are
at th
e bo
ttom
of
the
scre
en.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
16
OH
IO
Web
site
: w
ww
.insu
ranc
e.oh
io.g
ov
C
onta
cts:
T
axes
: ta
xes@
insu
ranc
e.oh
io.g
ov
Inst
ruct
ion
s:
FO
RM
S A
CC
EP
TA
BL
E F
OR
FIL
ING
AR
E N
OT
AV
AIL
AB
LE
ON
TH
E I
NT
ER
NE
T W
ITH
OU
T A
US
ER
ID
AN
D
PA
SS
WO
RD
. Sam
ple
for
ms
may
be
view
ed w
ith
out
a U
ser
ID a
nd p
assw
ord
at
ww
w.in
sura
nce
.oh
io.g
ov d
irec
tly
by
clic
kin
g on
“I
nsur
ers –
How
do
I” o
n ou
r ho
mep
age,
an
d th
en “
Obt
ain
form
s for
insu
rers
” T
ax r
etur
ns m
ust b
e fi
led
onlin
e by
thei
r du
e da
tes
thro
ugh
a se
cure
web
site
usi
ng a
Use
r ID
and
pas
swor
d pr
evio
usly
pro
vide
d to
the
com
pany
trea
sure
r by
the
Ohi
o D
epar
tmen
t of
Insu
ranc
e (O
DI)
. To
acce
ss ta
x fo
rms
for
fili
ng, s
elec
t “S
ecur
ed L
ogon
” on
the
uppe
r le
ft-
hand
sid
e of
the
OD
I ho
mep
age
at w
ww
.insu
ranc
e.oh
io.g
ov. T
hen
scro
ll do
wn
the
page
and
sel
ect “
Pre
miu
m T
ax F
iling
s/Fo
rms
– A
DM
ITT
ED
IN
SUR
ER
S O
NL
Y”
to f
ile p
rem
ium
taxe
s or
to v
iew
and
pri
nt O
ctob
er a
dvan
ce p
aym
ent i
nvoi
ces
and
ente
r th
e co
mpa
ny’s
U
ser
ID a
nd p
assw
ord.
Use
r ID
s an
d pa
ssw
ords
are
con
fide
ntia
l and
can
onl
y be
obt
aine
d by
the
com
pany
trea
sure
r or
his
or
her
desi
gnee
vi
a no
tari
zed
affi
davi
t. C
onta
ct ta
xes@
insu
ranc
e.oh
io.g
ov f
or in
stru
ctio
ns r
egar
ding
lost
Use
r ID
s an
d pa
ssw
ords
or
to o
btai
n ad
ditio
nal
info
rmat
ion.
Use
r ID
s and
pas
swor
ds c
anno
t be
crea
ted
onlin
e.
Com
plet
e an
d su
bmit
the
requ
ired
tax
form
s on
line
by th
eir
due
date
s. F
ollo
win
g on
line
subm
issi
on, a
ll pr
emiu
m ta
x re
turn
s sh
ould
be
prin
ted
for
com
pany
rec
ord
keep
ing
purp
oses
onl
y. T
he O
DI
no lo
nger
acc
epts
har
dcop
y fi
ling
of
tax
retu
rns.
Tax
ret
urns
are
ent
irel
y PA
PER
LESS
, exc
ept f
or th
e T
ax S
umm
ary
tran
smit
tal f
orm
s th
at g
o to
the
Tre
asur
er o
f St
ate
(IN
S721
4 an
d IN
S721
5).
Ple
ase
be a
war
e of
the
adm
inis
trat
ive
rule
s fo
r al
l ins
uran
ce p
rem
ium
tax
paym
ents
. O
hio
Adm
inis
trat
ive
Rul
e 11
3-4-
01 r
eads
as
follo
ws:
T
he p
aym
ent o
f an
y ta
x bi
ll is
sued
by
the
trea
sure
r of
sta
te o
r th
e su
peri
nten
dent
of
insu
ranc
e up
on th
e m
utua
l agr
eem
ent o
f th
e su
peri
nten
dent
and
the
trea
sure
r pu
rsua
nt to
§ 5
725.
22 o
f th
e R
evis
ed C
ode
shal
l be
mad
e in
acc
orda
nce
with
the
prov
isio
n of
this
rul
e.
(A)
Met
hod
of p
aym
ent:
Pay
men
ts m
ust b
e m
ade
by e
lect
roni
c fu
nds
tran
sfer
and
pay
able
to U
nite
d S
tate
s do
llars
. (B
) T
imel
ines
of
paym
ent:
Reg
ardl
ess
of th
e m
etho
d of
pay
men
t use
d, th
e pa
ymen
t mus
t be
mad
e to
the
trea
sure
r on
or
befo
re th
e du
e da
te s
peci
fied
on
the
tax
bill
or b
y th
e en
d of
the
firs
t bus
ines
s da
y im
med
iate
ly f
ollo
win
g th
e du
e da
te, i
f su
ch d
ue d
ate
falls
on
a S
atur
day,
a S
unda
y or
a h
olid
ay. F
or p
urpo
ses
of d
eter
min
ing
the
timel
ines
s of
a p
aym
ent a
nd th
e im
posi
tion
of a
ny p
enal
ty f
or la
te
paym
ent,
as m
ay b
e pr
ovid
ed f
or b
y la
w, p
aym
ent i
s co
nsid
ered
to b
e m
ade
whe
n it
is r
ecei
ved
by th
e tr
easu
rer,
irre
spec
tive
of a
ny
Uni
ted
Sta
tes
post
al s
ervi
ce m
arki
ng o
r ot
her
stam
p or
mar
k in
dica
ting
the
date
on
whi
ch th
e pa
ymen
t may
hav
e be
en m
aile
d.
Oh
io (
con
tinu
ed)
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
17
OH
IO (
cont
.)
Thi
s ru
le w
ill b
e in
eff
ect s
tart
ing
the
last
wee
k of
Jan
uary
201
3 an
d al
l pay
men
ts s
tart
ing
on J
anua
ry 2
8, 2
013
will
nee
d to
be
mad
e to
th
e T
reas
urer
of
Sta
te b
y A
CH
cre
dit o
r A
CH
deb
it. T
he w
ebsi
te to
reg
iste
r fo
r A
CH
pay
men
t is:
ht
tp://
eft.t
os.o
hio.
gov/
Dow
nloa
dPag
e.as
px
Onc
e re
gist
ered
for
one
of
the
AC
H p
aym
ent o
ptio
ns th
e T
reas
urer
’s o
ffic
e w
ill e
mai
l the
inst
ruct
ions
for
mak
ing
paym
ents
. Con
tact
the
Tre
asur
er’s
off
ice
dire
ctly
with
que
stio
ns r
egar
ding
this
pro
cess
, 614
-752
-848
4 or
vie
w th
e FA
Q’s
for
m a
t ht
tp://
eft.t
os.o
hio.
gov/
#/F
aqV
iew
A
ttach
men
ts to
tax
retu
rns
mus
t be
subm
itte
d on
line
alon
g w
ith th
e ta
x re
turn
. Ple
ase
refe
r to
“A
nnua
l Fili
ng R
equi
rem
ents
” on
the
OD
I W
ebsi
te, l
ocat
ed u
nder
the
“Ris
k A
sses
smen
t” ta
b, u
nder
“O
DI
Ser
vice
s” o
n th
e O
DI
hom
epag
e. O
nce
ther
e, s
elec
t you
r co
mpa
ny ty
pe to
fi
nd th
e ap
prop
riat
e ta
x re
turn
(s)
and
othe
r fo
rms
and
inst
ruct
ions
. Alte
rnat
ivel
y, f
orm
s ca
n be
loca
ted
by f
ollo
win
g th
e “F
orm
s” li
nk
belo
w.
Sam
ple
form
s, a
s w
ell a
s on
line
for
ms,
may
be
acce
ssed
und
er e
ach
of th
ese
“com
pany
type
” lo
cati
ons.
Tax
ret
urns
mus
t be
file
d on
-lin
e.
Do
not f
ile h
ardc
opy
tax
retu
rns.
Do
not s
end
paym
ents
to th
e O
hio
Dep
artm
ent o
f Ins
uran
ce. F
ollo
w p
aym
ent i
nstr
uctio
ns o
n F
orm
s IN
S721
4 an
d IN
S721
5.
ALL
TA
X P
AYM
EN
TS m
ust b
e m
ade
via
EF
T to
the
Tre
asur
er o
f S
tate
of
Ohi
o, a
nd e
mai
l Tax
Sum
mar
y (I
NS7
214
and
INS7
215)
to
Kel
ly.A
lvis
@to
s.oh
io.g
ov. D
o N
OT
sen
d a
copy
of
the
Tax
Sum
mar
y to
the
Dep
artm
ent o
f In
sura
nce.
Do
NO
T s
end
Tax
Sum
mar
y fo
rms
to th
e T
reas
urer
of
Sta
te if
no
bala
nce
is d
ue. D
o N
OT
sen
d ta
x pa
ymen
ts to
the
Dep
artm
ent o
f In
sura
nce.
Che
cks
rece
ived
by
the
Dep
artm
ent o
f In
sura
nce
may
be
retu
rned
and
sub
ject
to p
enal
ties.
E
stim
ated
Tax
es-A
utho
rize
d In
sure
rs
Ohi
o do
es N
OT
req
uire
aut
hori
zed
insu
ranc
e co
mpa
nies
to m
ake
quar
terl
y es
tim
ates
of
prem
ium
, fra
nchi
se o
r fi
re m
arsh
al ta
xes.
H
owev
er, a
ll in
sura
nce
com
pani
es f
iling
an
Ohi
o pr
emiu
m a
nd/o
r fi
re m
arsh
al ta
x re
turn
for
the
prev
ious
yea
r m
ust s
ubm
it a
n ad
vanc
e pa
ymen
t via
AC
H c
redi
t or
debi
t alo
ng w
ith a
cop
y of
the
adva
nce
paym
ent i
nvoi
ce to
the
Tre
asur
er o
f S
tate
by
Oct
ober
15t
h of
eac
h ye
ar. I
nvoi
ces
for
adva
nce
paym
ents
are
aut
omat
ical
ly c
alcu
late
d an
d pl
aced
on
the
Ohi
o D
epar
tmen
t of
Insu
ranc
e w
ebsi
te in
Sep
tem
ber.
T
o pr
int t
he a
dvan
ce p
aym
ent i
nvoi
ce, e
nter
the
secu
red
logo
n at
the
top
of th
e O
DI
hom
epag
e an
d lo
gon
to th
e pr
emiu
m ta
x da
taba
se
(Pre
miu
m T
ax F
iling
s/Fo
rms
– A
DM
ITT
ED
IN
SU
RE
RS
ON
LY
) us
ing
your
Com
pany
’s p
revi
ousl
y-as
sign
ed p
rem
ium
tax
logo
n U
ser
ID
and
pass
wor
d (t
he s
ame
ones
use
d to
file
the
com
pany
’s ta
x re
turn
due
Mar
ch 1
). O
nce
insi
de th
e pr
emiu
m ta
x da
taba
se, g
o to
the
Tax
F
orm
s In
dex
page
and
sel
ect “
Ohi
o T
reas
urer
Oct
ober
Adv
ance
Pay
men
t Inv
oice
”. O
hio
does
not
req
uire
any
oth
er e
stim
ated
pay
men
ts.
Oh
io (
con
tinu
ed)
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
18
OH
IO (
cont
.)
You
mu
st r
etu
rn a
cop
y of
you
r in
voic
e to
th
e T
reas
ure
r of
Sta
te v
ia e
mai
l to
Kel
ly.A
lvis
@to
s.oh
io.g
ov. D
o n
ot s
end
you
r ch
eck
or a
cop
y of
you
r in
voic
e to
th
e D
epar
tmen
t of
In
sura
nce
.
Pen
altie
s an
d in
tere
st m
ay b
e as
sess
ed f
or la
te p
aym
ents
.
F
orm
s:
http
://w
ww
.insu
ranc
e.oh
io.g
ov/F
orm
s/P
ages
/For
msT
ab3.
aspx
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
19
OK
LA
HO
MA
W
ebsi
te:
http
://w
ww
.ok.
gov/
oid
C
onta
cts:
G
ail L
oPre
sto
(405
) 52
2-04
73
Gai
l.LoP
rest
o@oi
d.ok
.gov
Inst
ruct
ion
s:
Und
er R
egul
ated
Ent
ities
men
u, c
lick
on I
nsur
ers
and
then
clic
k on
Fin
anci
al
For
ms.
OR
EG
ON
W
ebsi
te:
http
://w
ww
.insu
ranc
e.or
egon
.gov
/
Con
tact
s:
Lyn
ette
Had
ley
(5
03)
947-
7046
L
ynet
te.M
.Had
ley@
oreg
on.g
ov
Inst
ruct
ion
s:
Onl
y th
e O
cean
Mar
ine
Tax
for
m is
ava
ilab
le s
epar
atel
y. A
ll o
ther
for
ms
are
file
d on
the
i-R
eg F
ilin
g sy
stem
. See
“li
nks”
for
a li
nk to
the
syst
em. A
log-
on is
req
uire
d.
Web
site
for
I-
Reg
Sys
tem
: F
iling
sys
tem
for
all
tax
form
s (e
xcep
t Oce
an M
arin
e T
ax):
ht
tps:
//ww
w4.
cbs.
stat
e.or
.us/
exs/
ins/
ireg
/ C
onta
ct a
tax
anal
yst (
liste
d to
the
side
) fo
r th
e co
mpa
ny a
utho
riza
tion
code
. In
sure
rs n
eedi
ng th
e A
sses
smen
t cou
pon,
the
Spe
cial
Ore
gon
Sch
edul
e P
fo
rm, t
he p
repa
ymen
t cou
pons
, or
the
Ore
gon
Insu
ranc
e T
ax R
etur
n ne
ed to
go
to th
e i-
Reg
sys
tem
. For
add
ition
al in
form
atio
n re
gard
ing
a fo
rm, p
leas
e co
ntac
t a ta
x an
alys
t.
G
ail M
cFar
lin
(503
) 94
7-72
18
Gai
l.L.M
cFar
lin@
oreg
on.g
ov
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
20
PE
NN
SY
LV
AN
IA
Web
site
: ht
tp:/
/ww
w.r
even
ue.s
tate
.pa.
us/p
orta
l/ser
ver.
pt/c
omm
unity
/rev
enue
_hom
e/1
0648
Con
tact
s:
Mar
ilyn
Wel
ls
(717
) 78
3-95
10
mw
ells
@pa
.gov
Inst
ruct
ion
s:
Clic
k on
For
ms
& P
ublic
atio
ns, n
ext c
lick
on F
orm
s fo
r B
usin
esse
s, th
en
Cor
pora
tion
Tax
es o
r ht
tp:/
/ww
w.r
even
ue.s
tate
.pa.
us/p
orta
l/ser
ver.
pt/c
omm
unity
/cor
pora
tion_
tax/
1471
2/
RC
T-1
21-A
, Gro
ss P
rem
ium
Tax
Rep
ort –
For
Dom
estic
Cas
ualty
, D
omes
tic
Fir
e or
Dom
esti
c L
ife
Insu
ranc
e C
ompa
nies
, Ass
ocia
tion
s or
E
xcha
nges
. In
stru
ctio
ns: R
CT
-121
A-I
R
CT
-121
-B, G
ross
Pre
miu
m T
ax R
epor
t -Fo
r F
orei
gn L
ife
or F
orei
gn T
itle
In
sura
nce
Com
pani
es, A
ssoc
iatio
ns o
r E
xcha
nges
In
stru
ctio
ns: R
CT
-121
B-I
R
CT
-121
-C, G
ross
Pre
miu
m T
ax R
epor
t - F
or F
orei
gn C
asua
lty o
r Fo
reig
n F
ire
Insu
ranc
e C
ompa
nies
, Ass
ocia
tion
s or
Exc
hang
es.
Inst
ruct
ions
: RC
T-1
21C
-1
Jo
seph
Clo
ver
III
(717
) 78
3-60
41
jclo
ver@
pa.g
ov
PU
ER
TO
RIC
O
Web
site
: ht
tp://
ww
w.o
cs.g
obie
rno.
pr
C
onta
cts:
G
lori
mar
San
tiag
o (7
87)
304-
3636
, ext
. 440
0 gs
antia
go@
ocs.
gobi
erno
.pr
Inst
ruct
ion
s:
For
ms
avai
labl
e th
roug
h O
PT
ins.
For
sam
ple
form
s, g
o to
: ht
tp://
ww
w.o
cs.g
obie
rno.
pr/o
cspr
/inde
x.ph
p?op
tion=
com
_con
tent
&vi
ew=
art
icle
&id
=26
4&It
emid
=14
5 an
d sc
roll
dow
n to
the
requ
ired
for
m.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
21
RH
OD
E I
SL
AN
D
Web
site
: w
ww
.tax.
ri.g
ov
C
onta
cts:
R
icha
rd C
oia
(Dep
t. of
Rev
enue
)
(401
) 57
4-88
49
Ric
hard
.Coi
a@ta
x.ri
.gov
Inst
ruct
ion
s:
Ele
ctro
nic
filin
g of
ret
urns
usi
ng th
e O
PT
ins s
yste
m o
f th
e N
AIC
is
pref
erre
d. P
aper
for
ms
are
avai
labl
e on
the
web
site
, on
the
left
clic
k on
“F
orm
s”, t
hen
clic
k on
pro
per
head
ing
to lo
cate
pre
miu
m ta
x fo
rms.
P
atri
ck G
enga
rella
(D
ept.
of R
even
ue)
(401
) 57
4-87
71
Pat
rick
.Gen
gare
lla @
tax.
ri.g
ov
L
eo L
ebeu
f (D
ept.
of R
even
ue)
(401
) 57
4-89
83
leo.
lebe
uf@
tax.
ri.g
ov
SO
UT
H C
AR
OL
INA
W
ebsi
te:
ww
w.d
oi.s
c.go
v
Con
tact
s:
Sha
ron
Wad
dell
(T
ax M
anag
er)
(803
) 73
7-49
10
swad
dell@
doi.s
c.go
v
Inst
ruct
ion
s:
Eff
ectiv
e 2/
15/2
011,
Sou
th C
arol
ina
requ
ires
ele
ctro
nic
filin
g of
fee
and
tax
retu
rns.
App
lica
ble
inst
ruct
ions
may
be
acce
ssed
via
the
Dep
artm
ent’
s w
ebsi
te. T
here
are
no
pape
r fo
rms
to f
ile.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
22
SO
UT
H D
AK
OT
A
Web
site
: w
ww
.DL
R.S
D.G
OV
/ins
uran
ce -
- FO
R P
AY
ME
NT
VO
UC
HE
RS
ON
LY
. T
he p
aym
ents
are
stil
l mad
e by
pri
ntin
g th
e vo
uche
r an
d at
tach
ing
a ch
eck
and
mai
ling
to th
e R
emit
tanc
e C
ente
r at
the
addr
ess
note
d on
the
vouc
her.
P
RE
MIU
M T
AX
RE
TU
RN
S a
re b
eing
com
plet
ed E
LE
TR
ON
ICA
LL
Y
thro
ugh
Tri
-Tec
h at
: ht
tp://
ww
w.tr
itech
soft
.com
/efi
lene
tsd/
efile
nets
d/ef
ilede
faul
tsd.
aspx
Con
tact
s:
Lua
nn J
ohns
on
(605
) 77
3-35
63
Lua
nn.J
ohns
on@
stat
e.sd
.us
Inst
ruct
ion
s:
TE
NN
ES
SE
E
Web
site
: ht
tp://
ww
w.tn
.gov
/insu
ranc
e/in
dex.
shtm
l ht
tp://
ww
w.tn
.gov
/insu
ranc
e/pr
emiu
mta
x.sh
tml
Con
tact
s:
Jam
es A
yers
(L
ead
Pre
miu
m T
ax)
(615
) 74
1-12
03
jam
es.a
yers
2@tn
.gov
Inst
ruct
ion
s:
OP
Tin
s is
the
pref
erre
d m
etho
d fo
r su
bmitt
ing
prem
ium
taxe
s an
d fe
es;
how
ever
, pap
er f
iling
is p
erm
itted
. Com
pani
es th
at c
hoos
e no
t to
file
el
ectr
onic
ally
can
acc
ess
the
abov
e w
ebsi
te f
or ta
x fo
rms
and
rela
ted
inst
ruct
ions
.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
23
TE
XA
S W
ebsi
te:
http
://c
ompt
roll
er.te
xas.
gov/
Con
tact
s:
Lis
a D
avis
(51
2) 4
63-7
587
lisa.
davi
s@cp
a.te
xas.
gov
Inst
ruct
ion
s:
On
the
Tex
as C
ompt
rolle
r’s
hom
e pa
ge, u
nder
“F
ile/R
epor
t and
Pay
Tax
es”
on th
e le
ft h
and
side
of
the
page
, sel
ect “
Tax
For
ms.
” O
n th
e ne
xt p
age,
und
er T
ax F
orm
s (A
-Z),
cho
ose
“Ins
uran
ce T
ax.”
T
he f
orm
s ap
plic
able
to in
sure
rs li
cens
ed to
do
busi
ness
in T
exas
are
: 25
-100
A
nnua
l Ins
uran
ce P
rem
ium
Tax
Rep
ort
25-1
01
Insu
ranc
e S
emi-
Ann
ual P
rem
ium
Tax
Pay
men
t 25
-102
In
sura
nce
Mai
nten
ance
, Ass
essm
ent a
nd R
etal
iato
ry R
epor
t 25
-106
A
utom
obile
Bur
glar
y an
d T
heft
Pre
vent
ion
Aut
hori
ty A
sses
smen
t Rep
ort
25-1
07
Aut
omob
ile B
urgl
ary
and
The
ft P
reve
ntio
n A
utho
rity
Ass
essm
ent S
emi-
Ann
ual P
aym
ent W
orks
heet
25
-200
R
etal
iato
ry W
orks
heet
25
-205
C
ompu
tatio
n of
Non
-Tax
able
Pre
miu
ms
25-3
00
Ann
ual I
nsur
ance
Mai
nten
ance
, Ass
essm
ent,
and
Ret
alia
tory
Rep
ort I
nstr
uctio
ns
25-1
24
Ann
ual I
nsur
ance
Pre
miu
m T
ax R
epor
t for
Lic
ense
d C
apti
ve I
nsur
ance
Com
pani
es
In a
dditi
on, c
erta
in in
sure
rs a
re s
ubje
ct to
the
Vol
unte
er F
ire
Dep
artm
ent A
ssis
tanc
e F
und
asse
ssm
ent.
Thi
s fo
rm is
not
ava
ilab
le o
n-lin
e.
The
Com
ptro
ller
’s o
ffic
e ge
nera
tes
a bi
llin
g an
d m
ails
this
info
rmat
ion
to a
ll af
fect
ed in
sure
rs. T
his
asse
ssm
ent m
ay b
e re
coup
ed d
irec
tly
from
pol
icyh
olde
rs.
EL
EC
TR
ON
IC P
AY
ING
: T
axpa
yers
who
pai
d $1
0,00
0 or
mor
e in
the
prec
edin
g st
ate
fisc
al y
ear
mus
t m
ake
thei
r in
sura
nce
tax
paym
ents
ele
ctro
nica
lly.
T
axpa
yers
in th
e $1
0,00
0 to
$99
,999
cat
egor
y ca
n m
ake
paym
ents
usi
ng W
ebE
FT
(el
ectr
onic
che
ck),
Web
cre
dit c
ard,
and
Tex
Net
. T
axpa
yers
who
pai
d $1
00,0
00 o
r m
ore
in ta
xes
in th
e pr
eced
ing
stat
e fi
scal
yea
r ar
e re
quir
ed to
sub
mit
thei
r pa
ymen
t thr
ough
Tex
Net
. E
LE
CT
RO
NIC
RE
PO
RT
ING
: T
axpa
yers
who
pai
d $5
0,00
0 or
mor
e in
the
prec
edin
g st
ate
fisc
al y
ear
mus
t al
so e
lect
roni
call
y fi
le th
eir
prem
ium
tax
repo
rts.
Ele
ctro
nic
filin
g of
pre
miu
m ta
x re
port
s is
vol
unta
rily
for
all
othe
r ta
xpay
ers.
Tax
paye
rs m
ay a
lso
volu
ntar
ily f
ile m
aint
enan
ce ta
xes
and
the
AB
PT
A
repo
rts
usin
g th
e W
ebF
ile
syst
em.
To
acce
ss W
ebF
ile:
htt
p://
com
ptro
ller
.texa
s.go
v/w
ebfi
le/
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
24
UT
AH
W
ebsi
te:
http
://ta
x.ut
ah.g
ov/
C
onta
cts:
T
echn
ical
Res
earc
h U
nit
(Uta
h T
ax C
omm
issi
on)
(801
) 29
7-77
05
taxm
aste
r@ut
ah.g
ov
Inst
ruct
ion
s:
Cho
ose
“For
ms
& p
ublic
atio
ns”
and
then
cho
ose
TC
-49
Inst
ruct
ions
and
T
C-4
9PC
(pa
ymen
t cou
pon)
. The
re is
a r
equi
rem
ent t
o fi
le th
e re
turn
el
ectr
onic
ally
thro
ugh
taxp
ayer
expr
ess.
utah
.gov
. To
requ
est a
PD
F v
ersi
on
of th
e fo
rm, c
onta
ct th
e U
tah
Sta
te T
ax C
omm
issi
on f
or m
ore
info
rmat
ion.
VE
RM
ON
T
Web
site
: w
ww
.sta
te.v
t.us/
tax
C
onta
cts:
Ju
dy H
unte
r (T
ax D
epar
tmen
t)
(802
) 82
8-68
38
judy
.hun
ter@
stat
e.vt
.us
Inst
ruct
ion
s:
Clic
k on
‘F
orm
s’ a
nd th
en ‘
Mis
cella
neou
s F
orm
s’, s
crol
l dow
n to
‘I
nsur
ance
’ w
here
the
“IP
T-6
33 I
nsur
ance
Pre
miu
m T
ax R
etur
n” a
nd th
e “P
E-6
32 E
stim
ate
of I
nsur
ance
Pre
miu
m T
ax”
form
s ar
e lo
cate
d.
VIR
GIN
ISL
AN
DS
Web
site
: w
ww
.ltg.
gov.
vi
Con
tact
s:
Julie
tte D
anie
l (P
&C
Fili
ngs)
(3
40)
774-
7166
Ext
. 452
2 ju
liette
.dan
iel@
lgo-
vi.g
ov
Inst
ruct
ion
s:
On
the
hom
e pa
ge, t
o th
e le
ft c
lick
on
“Ban
king
and
Ins
uran
ce”,
then
mid
-pa
ge c
lick
on “
Dow
nloa
d B
anki
ng a
nd I
nsur
ance
For
ms”
. Scr
oll t
o “P
rem
ium
tax”
and
clic
k on
“P
rem
ium
Tax
Qua
rter
For
m.”
V
anes
sa R
icha
rds
(L&
H F
ilin
gs)
(340
) 77
4-71
66 E
xt. 4
513
vane
ssa.
rich
ards
@lg
o-vi
.gov
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
25
VIR
GIN
IA
Web
site
: F
or M
aint
enan
ce a
nd s
peci
al a
sses
smen
ts-B
urea
u of
Ins
uran
ce
http
://w
ww
.scc
.vir
gini
a.go
v/bo
i/co/
asse
ss/f
iling
.asp
x F
or P
rem
ium
Lic
ense
Tax
-Dep
artm
ent o
f T
axat
ion
http
://w
ww
.tax.
virg
inia
.gov
/for
ms/
sear
ch/b
usin
ess/
Insu
ranc
e-P
rem
ium
s-L
icen
se-T
ax
Con
tact
s:
Joyc
e Jo
nes
(Bur
eau
of I
nsur
ance
) (8
04)
371-
9096
Jo
yce.
Jone
s@sc
c.vi
rgin
ia.g
ov
Inst
ruct
ion
s:
For
Bu
reau
of
Insu
ran
ce:
For
ms
avai
labl
e on
the
Inte
rnet
; how
ever
, the
y ar
e no
t vie
wab
le w
ithou
t a
com
pany
NA
IC n
umbe
r. F
orm
s ar
e al
so a
ccep
tabl
e th
roug
h an
A
PP
RO
VE
D p
rem
ium
tax
soft
war
e de
velo
pmen
t com
pany
. C
lick
on D
ownl
oad
Ann
ual A
sses
smen
t For
ms.
Aft
er r
eadi
ng th
e in
stru
ctio
ns, c
lick
on th
e la
st s
ente
nce
that
’s u
nder
lined
and
sta
tes
“I h
ave
read
thes
e in
stru
ctio
ns in
thei
r en
tire
ty a
nd w
ish
to p
roce
ed to
dow
nloa
d th
e ap
prop
riat
e an
nual
ass
essm
ent f
orm
s.”
Ent
er th
e co
mpa
ny’s
NA
IC n
umbe
r an
d cl
ick
‘Con
tinue
’. T
he li
st o
f fo
rms,
by
nam
e an
d nu
mbe
r, r
equi
red
to b
e fi
led
wil
l app
ear
in li
nk
form
at. C
lick
on th
e lin
k an
d th
e ac
tual
for
m w
ill a
ppea
r.
For
Dep
artm
ent
of T
axat
ion
: P
rem
ium
tax
form
s ar
e av
aila
ble
on T
AX
’s w
eb s
ite.
Qua
rter
ly e
stim
ated
pa
ymen
ts c
an b
e m
ade
elec
tron
ical
ly u
sing
efo
rms.
Ann
ual T
AX
fil
ings
fo
rms
are
also
ava
ilab
le, b
ut m
ust b
e fi
led
man
uall
y.
L
en M
anga
nello
(D
ept.
of T
axat
ion)
(8
04)
404-
4163
le
n.m
anga
nello
@ta
x.vi
rgin
ia.g
ov
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
26
WA
SHIN
GT
ON
W
ebsi
te:
ww
w.in
sura
nce.
wa.
gov
C
onta
cts:
T
ierr
a D
icki
nson
(36
0) 7
25-7
031
Kri
scin
da H
anse
n (3
60)
725-
7032
ta
xes@
OIC
.wa.
gov
E-T
ax L
ink
: ht
tps:
//for
tres
s.w
a.go
v/oi
c/on
lines
ervi
ces/
Log
in.a
spx?
mod
ule=
TA
X
Inst
ruct
ion
s:
Pre
miu
m T
ax f
orm
s fo
r fi
ling
are
only
ava
ilabl
e w
ith a
use
r na
me
and
pass
wor
d pr
ovid
ed b
y th
e O
ffic
e of
Ins
uran
ce C
omm
issi
oner
. If
a us
er
nam
e an
d pa
ssw
ord
is r
equi
red
and
has
not b
een
prov
ided
, ple
ase
cont
act
the
Off
ice
of I
nsur
ance
Com
mis
sion
er.
To
acce
ss th
e fi
ling
sys
tem
, ple
ase
visi
t the
E-T
ax w
ebsi
te a
bove
. Thi
s li
nk w
ill t
ake
you
to th
e el
ectr
onic
tax
form
sit
e. T
he lo
g in
is o
n th
e le
ft
side
of
the
page
. PA
PE
R T
AX
FO
RM
S A
RE
NO
T A
CC
EP
TE
D u
nles
s pr
e-ap
prov
ed b
y th
e O
ffic
e of
Ins
uran
ce C
omm
issi
oner
. Was
hing
ton
Stat
e ta
x fo
rms
are
acce
ssed
, com
plet
ed a
nd s
ubm
itte
d on
line.
In
stru
ctio
ns f
or f
iling
are
ava
ilabl
e on
the
web
site
: ht
tp://
ww
w.in
sura
nce.
wa.
gov/
for-
insu
rers
/pre
miu
m-t
axes
-reg
ulat
ory-
surc
harg
e/pr
emiu
m-t
axes
/pt-
filin
g-in
stru
ctio
ns/
If y
ou n
eed
sam
ple
for
ms,
ple
ase
con
tact
th
e O
ffic
e of
In
sura
nce
C
omm
issi
oner
.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
27
WE
ST
VIR
GIN
IA
Web
site
: w
ww
.wvi
nsur
ance
.gov
Con
tact
s:
Tax
Aud
it S
ectio
n (3
04)
558-
2100
Inst
ruct
ion
s:
Wes
t Vir
gini
a fo
r ta
x ye
ar 2
014
is a
ccep
ting
the
Ann
ual P
rem
ium
Tax
S
tate
men
t and
alo
ng w
ith
the
Ann
ual T
ax P
aym
ent F
orm
thro
ugh
OPT
Ins.
How
ever
, thi
s is
not
a r
equi
rem
ent.
The
for
ms
are
also
loca
ted
on o
ur
web
site
at:
ht
tp://
ww
w.w
vins
uran
ce.g
ov/c
ompa
ny/T
axes
/tabi
d/36
9/D
efau
lt.as
px
The
re a
re F
iling
Ins
truc
tions
and
Det
aile
d In
stru
ctio
ns f
or th
ese
form
s on
ou
r w
ebsi
te. Y
ou m
ay f
ile y
our
tax
paym
ent t
hrou
gh O
PT
ins (
Onl
ine
Pre
miu
m T
ax f
or I
nsur
ance
) or
by
chec
k. F
or Z
ER
O f
iles
only
, you
may
fi
le o
nlin
e by
goi
ng to
: ht
tp://
ww
w.w
vins
uran
ce.g
ov/s
urpl
uslin
esze
ropa
y.as
px
The
201
4 A
nnua
l Pre
miu
m T
ax S
tate
men
t may
be
subm
itte
d th
roug
h O
PT
Ins o
r th
e ha
rd c
opy
mus
t be
mai
led
to th
e O
ffic
es o
f th
e In
sura
nce
Com
mis
sion
er.
D
rem
a G
ools
by (
Tax
Aud
it C
lerk
) D
rem
a.G
ools
by@
wvi
nsur
ance
.gov
M
iche
lle
Far
ren
(Tax
Aud
it C
lerk
) M
iche
lle.
Far
ren@
wvi
nsur
ance
.gov
Syl
via
Bak
er (
Tax
Aud
it C
lerk
, Sr.
) S
ylvi
a.B
aker
@w
vins
uran
ce.g
ov
Rho
nda
Har
twel
l (In
s. F
in. S
peci
alis
t S
uper
viso
r)
Rho
nda.
Har
twel
l@w
vins
uran
ce.g
ov
WIS
CO
NS
IN
Web
site
: ht
tp://
oci.w
i.gov
/com
pany
/for
ms-
com
pany
.htm
Con
tact
s:
John
Litw
eile
r (6
08)
267-
4390
jo
hn.li
twei
ler@
wi.g
ov
In
stru
ctio
ns:
C
lick
on “
Ann
ual S
ched
ule
of T
axes
and
Fee
s”.
Fred
Tho
rnto
n (6
08)
267-
5295
fr
ed.th
ornt
on@
wi.g
ov
WY
OM
ING
W
ebsi
te:
http
://do
i.wyo
.gov
Con
tact
s:
Lin
da L
. Joh
nson
, C
hief
Fin
anci
al E
xam
iner
(3
07)
777-
5619
lin
da.jo
hnso
n@w
yo.g
ov
Inst
ruct
ion
s:
Clic
k on
“In
dust
ry”
(on
left
sid
e) to
take
you
to th
e sc
reen
that
has
the
prem
ium
tax
retu
rn.
Ret
alia
tion
—Ja
nuar
y 20
15
ST
AT
E T
AX
FO
RM
S
© 1
991-
2015
Nat
iona
l Ass
ocia
tion
of I
nsur
ance
Com
mis
sion
ers
28
