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DEPARTMENT OF INSURANCE, STATE OF WYOMING
106 EAST 6th AVENUE, CHEYENNE, WYOMING 82002
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Company:
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Address:
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NAIC No.FEIN:
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State of Domicile
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2025 UN-LICENSED COMPANY PREMIUM TAX RETURN
(Must be filed in hard copy & mailed to the Department with payment)
Make checks payable to the Wyoming State Treasurer and remit to the Department at the address above.
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Column 1 reports the amount of tax a Wyoming company would pay to your domiciled state if they had your written premium, and column 2 reports the amount of tax your company would pay to Wyoming based on Wyoming statutes.
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SUMMARY OF PREMIUM TAXESColumn 1
State of Incorporation		Column 2 State of Wyoming
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TAXES:
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1. Life (Sch. I – Line 12)0
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2. Annuities (Sch. II – Line 12a)0
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3. Otherxxxxxxxxxxxxxxxxxxx
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4. TOTAL TAXES00
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5. Enter the larger of column 1 or column 2, Total Taxes0
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LESS PAYMENTS:
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6. Prior year overpayment
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7. Quarterly Premium Taxes Paid
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NET AMOUNT0
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I declare under the penalties imposed by law that this return, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.
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______________________________________________________ _________________________________________
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Preparer’s Signature
Date
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______________________________________________________ _________________________________________
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Preparer’s Name Typed or Printed Telephone Number
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______________________________________________________ _________________________________________
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Preparer’s Title E-Mail Address
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SCHEDULE I
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LIFE TAXColumn 1
State of Incorporation		Column 2 State of Wyoming
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1.Total Life Premium Income54
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2.Other Income541xxxxxxxxxxxxxxxxxxx
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3.TOTAL INCOME595
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DEDUCT:
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4.Return Premiums on Canceled Policies
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5.Current Dividends Paid
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6.Life Premiums (Qualified Plans – Internal Revenue Code)
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7.Current Dividends Paid (Qualified Plans – Internal Revenue Code)
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8.Other Deductions
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9.TOTAL DEDUCTIONS00
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10.Net Taxable Premiums, if negative enter 05950
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11.Tax Rate0.75%
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12.Premium Tax - Life00
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SCHEDULE II
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ANNUITY TAXColumn 1
State of Incorporation		Column 2 State of Wyoming
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1a. Total Annuity Considerations Premium Income
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2a. Other Incomexxxxxxxxxxxxxxxxxxxx
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3a. TOTAL INCOME0
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DEDUCT:
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4a. Return Premiums on Canceled Policies
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5a. Current Dividends Paid
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6a. Annuity Premiums (Qualified Plans – Internal Revenue Code)
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7a. Current Dividends Paid (Qualified Plans – Internal Revenue Code)
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8a. Other Deductionsxxxxxxxxxxxxxxxxxxxx
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9a. TOTAL DEDUCTIONS00
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10a. Net Taxable Premiums00
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11a. Tax Rate1.0%
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12a. Premium Tax - Annuities00
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Definitions
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Premium taxes – Generally, Wyo. Stat. § 26-4-103(a): Each authorized and formerly authorized insurer shall file with the commissioner on or before March 1 each year, or within any extended period the commissioner grants not to exceed thirty (30) days, a report in a form the commissioner prescribes showing, except for wet marine and transportation insurance as defined in W.S. 26-5-107, total direct premium income including policy, membership and other fees, and all other considerations for insurance and annuity contracts, however designated, it received during the immediately preceding calendar year because of policies and contracts covering property, subjects or risks located, resident or to be performed in this state. The total direct premium income reported shall include proper proportionate allocation of premiums or consideration as to those persons, property, subjects or risks in this state insured or covered under policies or contracts covering persons, property, subjects or risks located or resident in more than one (1) state, and shall be computed after deducting: (i) The amount of return premiums on canceled policies, but not including the return of cash surrender values on life policies or annuity contracts; and (ii) The amount returned to policyholders as current dividends.
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Wyoming Statute § 26-3-102(b): An insurer not transacting new insurance business in Wyoming but continuing collection of premiums on and servicing policies remaining in force as to residents of or risks located in Wyoming is transacting insurance in Wyoming for the purpose of premium tax requirements only and is not required to have a certificate of authority. This subsection does not apply to insurers which withdrew from Wyoming prior to May 21, 1955.
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Wyoming Statute § 26-4-103(j): No tax is due or payable because of premiums or considerations received from policies or contracts issued in connection with a pension annuity or profit-sharing plan exempt or qualified under sections 401, 403, 404, 408, 457 or 501 of the United States Internal Revenue Code of 1954, as amended or renumbered.
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Retaliatory Provision, Wyo. Stat. § 26-3-130(a): The commissioner shall impose upon any insurer, or upon the agent or representative of that insurer of any other state or any foreign country doing business in Wyoming the same taxes, licenses and other fees, in the aggregate, and the same fines, penalties, deposit requirements or other material requirements, obligations, prohibitions or restrictions as are imposed upon Wyoming insurers, or upon
their agents or representatives, by the laws of any other state or any political subdivision thereof, or any country or any province or other political subdivision thereof.
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Premium Tax Return Line Instructions Summary of Premium Taxes
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Taxes
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 Enter the calculated premium taxes from Schedules I and II on the indicated lines.
The “Total Taxes” line is the basis for retaliation. Enter the larger of column 1 or column 2 on the line indicated.
Payments
Prior Year Overpayment – Enter amount of overpayment from 2024. Amount of credit must agree with the notification letter sent by the Wyoming Insurance Department.
Quarterly Premium Taxes Paid – Total of first, second, and third quarter payments made during 2025.
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SCHEDULE I
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LIFE TAX (Page 24, State Page):
LINE 1 Total Life Premium Income
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 The sum of lines 11 and 19, column 1 of page 24.
LINE 2 Other Income
Report the amount of any other additions/adjustments as required by the domicile state. Attach a retaliatory schedule supporting the amount recorded.
LINE 3 Total Income
Sum of Line 1 and Line 2.
LINE 4 Returned Premiums on Canceled Policies
Report the amount of returned premiums on canceled policies only if the premiums are included in line one.
LINE 5 Current Dividends Paid
The sum of lines 11 and 19, columns 3 and 4; and the sum of lines 11 and 19, columns 5 and 6, if they are included in lines 11 and 19, Column 1.
LINE 6 Life Premiums (Qualified Plans – Internal Revenue Code)
Enter the total of premiums received for policies or contracts issued in connection with qualified plans. See definitions.
LINE 7 Current Dividends Paid (Qualified Plans – Internal Revenue Code)
The amount in line 5 that applies to premiums included in line 6.
LINE 8 Other Deductions
Report any other deductions allowed. Attach a retaliatory schedule supporting the amount claimed.
LINE 9 Total Deductions
The sum of lines 4, 5, 6, and 8, minus line 7.
LINE 10 Net Taxable Premiums Line 3 minus line 9
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LINE 11 Tax Rate
The tax rate of the state of incorporation must be shown in the blank provided. If more than one rate is used to calculate the tax, attach a separate schedule showing the tax calculation for the state of incorporation.
LINE 12 Premium Tax - Life and Disability
Line 11 (rate) times line 10 (net taxable premiums).
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SCHEDULE II
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ANNUITY TAX (Page 24, State Page)
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LINE 1a Total Annuity Considerations Premium Income
Sum of lines 26 and 33, Column 1. Please note that deposit-type funds are not included in the calculation of the annuity tax.
LINE 2a Other Income
Other income/adjustments as required by the domicile state. Attach a retaliatory schedule supporting the amount reported.
LINE 3a Total Income
The sum of lines 1a and 2a.
LINE 4a Returned Premiums on Canceled Policies
Report the amount of returned premiums on canceled policies only if the premiums are included in line 1a.
LINE 5a Current Dividends Paid
The sum of lines 26 and 33, columns 3 and 4; and the sum of lines 26 and 33, columns 5 and 6, if amounts are included in lines 26 and 33, Column 1.
LINE 6a Annuity Premiums (Qualified Plans – Internal Revenue Code)
Enter the total of premiums received for policies or contracts issued in connection with a qualified pension annuity. See definitions.
LINE 7a Current Dividends Paid (Qualified Plans – Internal Revenue Code)
The amount in line 5a that relates to premiums in line 6a.
LINE 8a Other Deductions
Report any other deductions allowed by the domicile state. Attach a retaliatory schedule supporting the amount claimed.
LINE 9a Total Deductions
The sum of lines 4a, 5a, 6a, and 8a, less line 7a.
LINE 10a Net Taxable Premiums
Line 3a less line 9a.
LINE 11a Tax Rate
The tax rate of the state of incorporation must be shown in the blank provided. If more than one rate is used to calculate the tax, attach a separate schedule showing the tax calculation for the state of incorporation.
LINE 12a Premium Tax - Annuities
The tax rate on line 11a times net taxable premiums on line 10a.
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