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IMPORTANT Instructional Surplus Line Brokers and Special Lines Surplus Line Brokers, who held a license during the reporting year, whether business was transacted, must complete this form. Fill out
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What is Any questions regarding the completion of the Annual Statement and Tax Return please contact the California Department of Insurance Premium Tax Audit Bureau: Carlito Ramos at (213) 346-6265 or Mimi Tsang at (213) 346-6312 Form?

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