Fillable Form 115A , Premium Tax Return Tax on Premiums Paid to ... - ct

STATE OF CONNECTICUT DEPARTMENT OF REVENUE SERVICES PO BOX 2990 HARTFORD CT 06104-2990 FORM 115A PREMIUM TAX RETURN TAX ON PREMIUMS PAID TO UNAUTHORIZED INSURERS For Calendar Year FORM 115A (Rev. 12/99) 19 Connecticut Tax Registration Number Federal Employer Identification Number Date Received (For Department Use Only) Please change Name and/or Address if shown incorrectly at right SCHEDULE OF INSURANCE PURCHASED...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • eFax
  • Email
  • Add Annotations
  • Share
Fill Online
Rate This Form