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Premium Taxes

Effective

Policy effective date.

Policy No

Policy number.

Policyholder

Policy holder name.

City

Policy holder city.

St

Policy holder state.

Report Period

Reporting period.

Census

Policy enrollment.

State Tax Rate

Rate for state premium taxes.

Muni County

Municipal county tax on the premium.

County Rate

Rate for county premium taxes.

Muni City

Municipal city tax on the premium.

City Rate

Rate for city premium taxes.

Exception

Excepted tax amount.

Gross Premium

Total policy premium.

Premium Tax

Total taxes paid on the premium.