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25-101 (Rev.5-15/20) PRINT FORM RESET FORM Texas Semi-Annual Insurance Premium Tax Payment Worksheet (Licensed Insurance Companies, Licensed Captive Insurance Companies and Miscellaneous Organizations)

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Texas HMO prepayments TX webfile 2510101W051520 Preparer bTaxpayer 223A III comptroller Insurers Prepayment Worksheet shaded Aug aggregate taxed Statewide factored gov PREMIUMS Miscellaneous Stipulated REVENUES excluding captives Taxpayer CALCULATION DETA

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