Free DR-908 - Florida

Florida Department of Revenue Insurance Premium Taxes and Fees Return For Calendar Year 2008
DoR USE oNlY

DR-908 R. 01/09
Rule 12B-8.003 Florida Administrative Code Effective 01/09

PoSTMARk oR hAND DElIvERY DATE

FEIN
Name Address City/St/ZIP

Florida Code

Business Partner No.
Original Return Amended Return Reason for amended return: _____________________ _______________________________________________ Final Return

Computation of Insurance Premium Taxes and Fees
1. 2. 3. Total Premium Tax Due (Schedule I) ...................................................................................... Credits Against the Tax (Schedule III) .................................................................................... Net Premium Tax Due (If Line 1 minus Line 2 equals less than zero, enter zero) .......................................................................................... State Fire Marshal Regulatory Assessment (Schedule X) ...................................................... Wet Marine and Transportation Tax (Schedule XI) .................................................................. 1. 2. 3. 4. 5. 6. 7. 8. 9.

4. 5.

6. Firefighters'PensionTrustFund(ScheduleXII) ...................................................................... 7. MunicipalPoliceOfficers'RetirementTrustFund(ScheduleXIII) .......................................... 8. 9. 10. Retaliatory Tax (Schedule XIV) ................................................................................................ Filing Fee (Schedule XV) .........................................................................................................

DR-908

Commercial/Residential Policy Surcharge (Schedule XVI) plus Payment Due from Refund (Schedule XVII) .................................................................... 10. Total Tax Due (Sum of Line 3 through Line 10) ....................................................................... 11.

11.

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US Dollars

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Cents

The DR-908 is a machine-readable form. Please follow the hand print or machine print instructions. Use black ink.
If hand printing this document, print your numbers as shown and write one number per box. Write within the boxes.

0 1 2 3 4 5 6 7 8 9

If typing this document, type through the boxes and type all of your numbers together.

0123456789
DR-908 R. 01/09

Payment Coupon 2008 Insurance Premium Taxes and Fees
Check here if you transmitted funds electronically Enter name and address, if not pre-addressed:

Do not detach coupon.
Return is due March 1, 2009

To ensure proper credit to your account, enclose your check with tax return when mailing.

DR-908



Total amount due from Line 16
Name Address City/St/ZIP

Overpayment to be Refunded from Line 17
Enter FEIN if not pre-addressed

, ,

US Dollars

, ,

Cents

FEIN

Business Partner Number
Do Not Write in the Space Below

9100 0 20089999 0016045031 6 3999999999 0000 2

DR-908 R. 01/09 Page 2
12. Less: Installments Paid (include quarterly statement filing fees and surcharges). See instructions. 1st Quarter __________________________2nd Quarter ______________________ 3rd Quarter ___________________________ If amended, amount paid with original return ______________________________ Total Installment Payments ........................................................................................................... 12. 13. Net Tax Due or Overpayment (Line 11 minus Line 12) ...........................................
Check here if negative

13.

14. Penalty (10% Late Penalty) ........................................................................................................... 14. 15. Interest (See instructions) .............................................................................................................. 15. 16. Amount Due With This Return. Enter on payment coupon also. (Sum of Lines 13, 14, and 15. If less than zero, enter on Line 17) ............................................... 16. 17. overpayment to be Refunded. Enter on payment coupon also. (If amended, amount refunded with original _______________)..................................................... 17.
Contact person Phone number

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Fax number

US Dollars

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Cents

E-mail address

State of domicile

Location of corporate books

All Taxpayers Are Required to Answer Questions A and B Below as Appropriate.
A. Istheinsureramemberofanaffiliatedgroupwhoseparentcompany made a timely election, which included the insurer, for the alternative salary credit calculation under section (s.) 624.509(5)(a)2, Florida Statutes (F.S.)? (Refer to Schedule IV instructions for more information.) YES No B. DidyouusetheDepartment'saddressdatabaseorthirdpartysoftware, wherethesoftwarecompanyindicatedthattheyusedtheDepartment's address database, when you sourced your premiums to the local taxing jurisdictions reported on Schedule XII and/or Schedule XIII? (Refer to Schedule XII and XIII instructions for more information.) Department's database Software company's product where the software company indicated that they used the Department's address database No

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign here
Signatureofofficer(mustbeanoriginalsignature) Date Preparer's signature Firm'sname(oryours if self-employed) and address

Title
Preparer check if selfemployed FEIN ZIP Preparer's PTIN

Paid preparers only

Date

1. Have you signed your check? 2. Have you signed your return? 3. Have you attached the Florida Business Page of the Annual StatementfiledwiththeFlorida Department of Financial Services?

Make check payable and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0150

For refund mail to: Florida Department of Revenue PO Box 6440 Tallahassee FL 32314-6440

DR-908 R. 01/09 Page 3

Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SChEDUlE I CoMPUTATIoN oF INSURANCE PREMIUM TAx (Not To Be Used for Wet Marine and Transportation Tax) *** Include the Florida Business Page of Your Florida Annual Statement *** Types of Insurance 1. Property/Casualty/Miscellaneous a. Plus: Additional Taxable Premiums b. Less: Excluded Premiums c. Total Taxable Premiums 2. Life and Accident and Health a. Plus: Additional Taxable Premiums b. Less: Excluded Premiums c. Total Taxable Premiums 3. 4. 5. 6. 7. 8. 9. 10. 11. Prepaid Limited Health Service Organizations Commercial Self-Insurance Funds Group Self-Insurance Funds Medical Malpractice Self-Insurance Assessable Mutual Insurers CorporationNot-for-ProfitSelf-InsuranceFunds Public Housing Authorities Self-Insurance Funds (see instructions) Annuity Premiums (Schedule II, Line 3) Total Premium Tax Due (Add Lines 1c, 2c, and 3 through 10. Enter here and on Page 1, Line 1)* 1.75% 1.75% 1.60% 1.60% 1.60% 1.60% 1.60% 1.60% 1.75% Total Premiums Tax Rate Tax Due

* If zero or less, enter -0SChEDUlE II Types of Insurance 1. 2. 3. Annuity Premiums Premium Tax Savings Derived and Credited to the "holders" (If none, enter zero "0") Total Annuity Premiums Due (Line 1 minus Line 2. Enter here and on Schedule I, Line 10)* CREDITS AgAINST ThE PREMIUM TAx ANNUITY CoNSIDERATIoN PREMIUMS Total Premiums Tax Rate 1.00% Tax Due

* If zero or less, enter -0SChEDUlE III 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Workers'CompensationAdministrativeAssessmentCredit(ScheduleVI,Line4) Firefighters'PensionTrustFundCredit(ScheduleXII-B,Line3,minuscreditusedScheduleXI,Line6) MunicipalPoliceOfficers'RetirementTrustFundCredit (Schedule XIII - B, Line 3 minus credit used Schedule XI, Line 7) Eligible Corporate Income Tax and Emergency Excise Tax Credit (Schedule V, Line 11) ** Salary Tax Credit (Schedule V, Line 12 plus Schedule V, Line 13) CertifiedCapitalCompany(CAPCO)Credit Florida Life and Health Insurance Guaranty Association Credit (Schedule VII, Line 1) Community Contribution Credit (Total credits approved under s. 624.5105, F.S., minus credit used Schedule XI, Line 8) Child Care Tax Credits (Total credits approved less credits used on Schedule XI, Line 9) Capital Investment Tax Credit (Enter here and include in Schedule XIV, Line 12, Column A) Total Credits (Sum of Line 1 through Line 10. Enter here and on Page 1, Line 2)

** If you filed on a consolidated basis for corporate income tax, you MUST include a schedule showing how the credit is claimed by each subsidiary.

DR-908 R. 01/09 Page 4

Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SChEDUlE Iv 1. 2. 3. 4. 5. 6. 7. 8.

*** Include Your Florida Department of Revenue Forms UCT-6 and UCS-71 if Claiming this Credit ***
Total Premium Tax Due (Schedule I, Line 11) Less: Firefighters'PensionTrustFundCredit(ScheduleXII-B,Line3) MunicipalPoliceOfficers'RetirementTrustFundCredit(ScheduleXIII-B,Line3) Corporate Income and Emergency Excise Tax Paid (Florida Form F-1120, Line 14) Total (Line 1 minus Line 2 through Line 4)* Eligible Florida Salaries (See Instructions) Multiply Line 6 by .15 Salary Credit - (Enter the lesser of Line 5 or Line 7 here and on Schedule V, Line 4)* CoRPoRATE INCoME, EMERgENCY ExCISE AND SAlARY CREDIT lIMITATIoN

CoMPUTATIoN oF SAlARY CREDIT

* If zero or less, enter -0SChEDUlE v 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Total Corporate Income Tax and Emergency Excise Tax Paid (Florida Form F-1120, Line 14) Less: Corporate Income Tax Credit Taken against Wet Marine and Transportation Insurance Tax (Schedule XI, Line 5) Eligible Net Corporate Income Tax and Emergency Excise Tax (Line 1 minus Line 2) Salary Credit (Schedule IV, Line 8) Total Premium Tax Due (Schedule I, Line 11) Less: Workers'CompensationAdministrativeAssessmentCredit(ScheduleVI,Line4) Firefighters'PensionTrustFundCredit(ScheduleXII-B,Line3) MunicipalPoliceOfficers'RetirementTrustFundCredit(ScheduleXIII-B,Line3)

Premium Tax Due After Deductions (Line 5 minus Lines 6 through 8) Corporate Income Tax/Emergency Excise Tax and Salary Credit Limitation (Multiply Line 9 by .65) Eligible Net Corporate Income Tax and Emergency Excise Tax Credit (Enter the lesser of Line 3 or Line 10 here and on Schedule III, Line 4)* Salary Tax Credit (Enter the lesser of Line 4 or the difference between Lines 10 and 11 here and on Schedule III, Line 5).* A reduction to the salary credit may be required if the election under s. 624.509(5)(a)2, F.S., applies (see instructions). TransferofEnterpriseZoneExcessSalaryCreditfromAffiliate(ThislinecannotexceedLine10minus Lines 11 and 12. Include attachment per instructions.)

12.

13.

* If zero or less, enter -0** If you filed on a consolidated basis for corporate income tax, you MUST include a schedule showing how the credit is claimed by each subsidiary. SChEDUlE vI 1. 2. 3. WoRkERS' CoMPENSATIoN ADMINISTRATIvE ASSESSMENT CREDIT lIMITATIoN

*** Include Your Florida Carrier and Self Insurance Fund Quarterly Premium Reports if Claiming this Credit***
Workers'CompensationPremiumsWritten(AnnualStatement-FloridaBusiness,Line16)* Multiply Line 1 by .0175 (Self Insurers multiply by .016) AdministrativeAssessmentsPaidtoWorkers'CompensationTrustFund(FloridaCarrierandSelf Insurance Fund Quarterly Premium Reports must be attached) a. c. First Quarter Assessment ____________________ b. Second Quarter Assessment ______________ Third Quarter Assessment ___________________ d. Fourth Quarter Assessment _______________

Total Administrative Assessments Paid* 4. Workers'CompensationAdministrativeAssessmentCredit (Enter the lesser of Line 2 or 3 here and on Schedule III, Line 1)*

* If zero or less, enter -0-

DR-908 R. 01/09 Page 5

Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SCheDUle VII

*** Be Sure To Include Your FlAhIGA Certificates of Contribution if Claiming this Credit ***
Total Class B and C Assessments Paid - Refunds = Total Assessments Paid x Rate = Credit Amount Year

FloRIDA lIFe & heAlTh INSURANCe GUARANTY ASSoCIATIoN CReDIT (FlAhIGA)

Year

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 * 1996 1997 1998 * 1999 2000 2001 2002 2003 2004 2005 2006 2007 1. Total FLAHIGA Credit (Enter here and on Schedule III, Line 7)(1)
assessments to properly calculate the amount of FLAHIGA credit. (1) If zero or less, enter -0-

.001 .001 .001 .001 .001 .001 .001 .001 .001 .001 .001 .001 .001 .001 .050 .050 .050 .050 .050 .050 .050 .050 .050 .050 .050

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

* In 2002, refunds were issued by FLAHIGA from the 1995 and 1998 assessments. These refunds must be subtracted from the original

SChEDUlES vIII AND Ix

NoT USED

DR-908 R. 01/09 Page 6

Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SChEDUlE x 1. Fire - Residential 2. *Fire - Commercial 3. *Commercial Multiple Peril 4. *Farmowners Multiple Peril 5. *Crop Hail 6. Residential Allied Lines 7. *Commercial Allied Lines 8. Homeowners Multiple Peril 9. Ocean Marine 10. Inland Marine 11. Earthquake 12. Other 13. Total Taxable Premiums (Sum of Line 1 through Line 12) 14. State Fire Marshal Tax Due (Multiply Line 13 by .01) (2) 15. *Total Premiums Subject to Surcharge (See Instructions) 16. Surcharge Due (Multiply Line 15 by .001) (2) 17. (1) (2) Total State Fire Marshal Tax Due Plus Total Surcharge Due (Line 14 plus Line 16) (Enter here and on Page 1, Line 4) Report the combined total for both the "non-liability" and "liability" portions. If zero or less, enter -0(1)

STATE FIRE MARShAl REgUlAToRY ASSESSMENT TAx/SURChARgE Types of Fire Premiums Total Premiums Fire Percentage 93% 93% 15% 15% 0% 5% 5% 25% 10% 12% 5% Taxable Premiums

* * * * *

SChEDUlE xI 1. Net Premiums (See Instructions) 2. Less: Net Losses Paid

WET MARINE AND TRANSPoRTATIoN TAx

3. GrossUnderwritingProfit(Line1minusLine2)* 4. Wet Marine and Transportation Tax (Multiply Line 3 by .0075) 5. Corporate Tax Credit (Florida Form F-1120, Line 11 minus Line 12) 6. Firefighters'PensionTrustFundCredit(ScheduleXII-B,Line3) 7. MunicipalPoliceOfficers'RetirementTrustFundCredit(ScheduleXIII-B,Line3) 8. Community Contribution Credit (Total credits approved under s. 624.5105, F.S.) 9. Child Care Tax Credits (Total credits approved) 10. Net Tax Due (Line 4 minus Lines 5 through 9. Enter here and on Page 1, Line 5)

* If zero or less, enter -0-

DR-908 R. 01/09 Page 7

Name _____________________________________ FEIN _________________________________ Florida Code _____________
SChEDUlE xII - A Code 015 017 021 023 024 025 027 029 033 043 047 050 053 055 057 060 064 067 069 073 094 118 119 128 129 130 134 140 148 167 171 183 191 192 198 203 210 222 229 238 251 253 257 258 265 268 270 278 279 287 288 292 293 Municipality/ Fire Control District Boca Grande Fire Control Dist. Bonita Springs Fire Control Dist. Destin Fire Control District East Lake Tarpon Fire Control Dist. East Naples Fire Control District East Niceville Fire District Englewood Area Fire Control Dist. Estero Fire Prot. & Resc. Svc. Dist. Holley-Navarre Fire Control District Midway Fire District North Bay Fire District North Naples Fire Control District North River Fire Control District Ocean City-Wright Fire Control District Okaloosa Is. Fire Control District Palm Harbor Special Fire Control Dist. San Carlos Park Fire Service Dist. South Walton Fire Control District Southern Manatee Fire & Resc. Dist. St. Lucie County Fire District West Manatee Fire & Rescue Dist. Apopka Arcadia Atlantic Beach Atlantis Auburndale Avon Park Baldwin Bartow Belleair Belleair Bluffs Boca Raton Boynton Beach Bradenton Briny Breezes Brooksville Bunnell Cape Coral Casselberry Chattahoochee Clearwater Clermont Cocoa Cocoa Beach Cooper City Coral Gables Coral Springs Crescent City Crestview Dade City Dania Beach Davie Daytona Beach FIREFIghTERS' PENSIoN TRUST FUND Total Taxable Premiums Code Municipality/ Fire Control District 296 DeerfieldBeach 298 Deland 301 Delray Beach 303 Deltona 316 Dunedin 317 Dunnellon 326 Eatonville 331 Edgewater 349 Eustis 359 Fernandina Beach 361 Flagler Beach 371 Fort Lauderdale 374 Fort Myers 379 Fort Walton Beach 385 Fruitland Park 387 Gainesville 402 Golf 416 Greenacres 427 Gulfport 428 Gulf Stream 431 Haines City 432 Hallandale Beach 438 Havana 442 Hialeah 446 Highland Beach 452 Hillsboro Beach 458 Holly Hill 459 Hollywood 464 Homestead 475 Hypoluxo 477 Indialantic 480 Indian River Shores 491 Jacksonville (Consol.) 492 Jacksonville Beach 502 Jupiter Inlet Colony 505 Key Biscayne 506 Key Colony Beach 509 Key West 515 Kissimmee 521 LaBelle 530 Lake City 539 Lake Mary 544 Lake Wales 545 Lake Worth 546 Lakeland 551 Lauderhill 552 Lantana 553 Largo 554 Lauderdale-by-the-Sea 560 Leesburg 578 Longboat Key 579 Longwood Subtotal Total Taxable Premiums

DR-908 R. 01/09 Page 8

Name _____________________________________ FEIN _________________________________ Florida Code _____________
SChEDUlE xII - B Code Municipality/ Fire Control District 590 Lynn Haven 592 Macclenny 595 Madison 596 602 603 604 607 620 626 627 640 645 649 655 666 671 675 676 687 690 691 693 695 698 701 706 709 722 725 728 736 743 744 745 746 747 748 754 755 761 770 773 776 787 789 790 796 798 801 811 Maitland Mangonia Park Marathon Marco Island Marianna Melbourne Miami Miami Beach Milton Miramar Monticello Mount Dora Naples Neptune Beach New Port Richey New Smyrna Beach North Miami Beach North Port North Redington Beach Oakland Park Ocala Ocean Ridge Ocoee Okeechobee Oldsmar Orange Park Orlando Ormond Beach Oviedo Palatka Palm Bay Palm Beach Palm Beach Gardens Palm Beach Shores Palm Coast Panama City Panama City Beach Parkland Pembroke Pines Pensacola Perry Pinellas Park Plantation Plant City Pompano Beach Ponce Inlet Port Orange Punta Gorda FIREFIghTERS' PENSIoN TRUST FUND Total Taxable Premiums Code 816 824 825 831 836 844 846 849 855 856 865 869 870 874 875 896 900 909 916 918 919 920 921 925 926 930 938 941 944 946 947 966 978 980 984 985 986 Municipality/ Fire Control District Quincy Redington Beach Redington Shores Riviera Beach Rockledge Safety Harbor St. Augustine St. Cloud St. Petersburg St. Pete Beach Sanford Sarasota Satellite Beach Sebring Seminole South Pasadena Starke Sunrise Tallahassee Tampa Tamarac Tarpon Springs Tavares Temple Terrace Tequesta Titusville Valparaiso Venice Vero Beach Village of North Palm Beach Village of Palm Springs West Palm Beach Wilton Manors Windermere Winter Garden Winter Haven Winter Park Total Taxable Premiums

In addition to completing Schedule XII, you must answer Question B on Page 2. Subtotal from Page 7 ............................ 1. Subtotal from Page 8 ............................ 2. Total Tax ................................................ 3.
[line 1 plus line 2 times 1.85% (.0185). enter here and on Page 1, line 6]*

Use the physical location of the property when allocating premiums to the fire control district or municipality. Do NoT use ZIP codes. For more information, see instructions.

* If zero or less, enter -0-

DR-908 R. 01/09 Page 9

Name _____________________________________ FEIN _________________________________ Florida Code _____________
SChEDUlE xIII - A Code 106 118 119 128 130 132 134 141 148 151 167 169 183 191 192 203 212 222 229 251 253 257 258 265 268 270 278 279 287 288 292 293 296 298 301 317 326 331 349 359 361 371 374 377 379 384 387 400 415 416 425 Municipality Altamonte Springs Apopka Arcadia Atlantic Beach Auburndale Aventura Avon Park Bal Harbour Village Bartow Bay Harbor Island Belleair Belleview Boca Raton Boynton Beach Bradenton Brooksville Bushnell Cape Coral Casselberry Clearwater Clermont Cocoa Cocoa Beach Cooper City Coral Gables Coral Springs Crescent City Crestview Dade City Dania Beach Davie Daytona Beach DeerfieldBeach Deland Delray Beach Dunnellon Eatonville Edgewater Eustis Fernandina Beach Flagler Beach Fort Lauderdale Fort Myers Fort Pierce Fort Walton Beach Frostproof Gainesville Golden Beach Green Cove Springs Greenacres Gulf Breeze MUNICIPAl PolICE oFFICERS' RETIREMENT TRUST FUND Total Taxable Premiums Code Municipality Total Taxable Premiums

427 Gulfport 431 Haines City 432 Hallandale Beach 442 Hialeah 443 Hialeah Gardens 458 Holly Hill 459 Hollywood 461 Holmes Beach 464 Homestead 472 Howey-in-the-Hills 477 Indialantic 479 Indian Harbour Beach 480 Indian River Shores 481 Indian Shores 491 Jacksonville (Consol.) 492 Jacksonville Beach 501 Jupiter 505 Key Biscayne 509 Key West 515 Kissimmee 524 Lady Lake 526 Lake Alfred 530 Lake City 536 Lake Helen 539 Lake Mary 544 Lake Wales 545 Lake Worth 546 Lakeland 551 Lauderhill 552 Lantana 553 Largo 560 Leesburg 578 Longboat Key 579 Longwood 590 Lynn Haven 595 Madison 596 Maitland 604 Marco Island 607 Marianna 618 Medley 620 Melbourne 621 Melbourne Beach 626 Miami 627 Miami Beach 628 Miami Shores Village 629 Miami Springs 640 Milton 645 Miramar 649 Monticello 655 Mount Dora Subtotal

DR-908 R. 01/09 Page 10

Name _____________________________________ FEIN _________________________________ Florida Code _____________
SChEDUlE xIII - B Code 666 671 675 676 686 687 690 693 695 701 706 722 725 728 736 743 744 745 746 752 754 755 761 770 773 776 787 789 790 796 801 807 811 816 831 836 839 846 849 855 856 865 867 869 870 873 874 879 894 900 909 Municipality Naples Neptune Beach New Port Richey New Smyrna Beach North Miami North Miami Beach North Port Oakland Park Ocala Ocoee Okeechobee Orange Park Orlando Ormond Beach Oviedo Palatka Palm Bay Palm Beach Palm Beach Gardens Palmetto Panama City Panama City Beach Parkland Pembroke Pines Pensacola Perry Pinellas Park Plantation Plant City Pompano Beach Port Orange Port St. Lucie Punta Gorda Quincy Riviera Beach Rockledge Royal Palm Beach St. Augustine St. Cloud St. Petersburg St. Pete Beach Sanford Sanibel Sarasota Satellite Beach Sebastian Sebring Shalimar South Miami Starke Sunrise MUNICIPAl PolICE oFFICERS' RETIREMENT TRUST FUND Total Taxable Premiums Code 911 912 916 918 919 920 921 925 926 930 936 938 941 944 946 947 954 963 966 978 984 985 986 Municipality Surfside Sweetwater Tallahassee Tampa Tamarac Tarpon Springs Tavares Temple Terrace Tequesta Titusville Umatilla Valparaiso Venice Vero Beach Village of North Palm Beach Village of Palm Springs Wauchula West Melbourne West Palm Beach Wilton Manors Winter Garden Winter Haven Winter Park Total Taxable Premiums

In addition to completing Schedule XIII, you must answer Question B on Page 2. Subtotal from Page 9 ............................ 1. Subtotal from Page 10 .......................... 2. Total Tax ................................................ 3.
[line 1 plus line 2 times .85% (.0085). enter here and on Page 1, line 7]*

Use the physical location of the property when allocating premiums. Do NoT use ZIP codes. For more information, see instructions.

* If zero or less, enter -0-

DR-908 R. 01/09 Page 11

Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SChEDUlE xIv RETAlIAToRY TAx CoMPUTATIoN Column A State of Florida* 1. Net Premium Tax Due (Page 1, Line 3 plus Line 5. See note below) 2. 80% of Salary Tax Credit Taken (Page 3, Schedule III, Line 5) 3. Total Corporate Income Tax and Emergency Excise Tax (See note below) 4. Enterprise Zone Portion of 20% of Salary Credit Taken (See instructions) 5. Firefighters'PensionTrustFund 6. MunicipalPoliceOfficers'RetirementTrustFund 7. FIGA(PropertyPortionofAssessmentsOnly)(IncludeCertificates) 8. Fire Marshal Taxes 9. Annual and Quarterly Statement Filing Fees 10. AnnualLicenseTaxandCertificateofAuthority 11. Agents'Fees 12. Other Taxes and Fees (Include Schedule) 13. Workers'CompensationCredit 14. Total (Sum of Lines 1 through Line 13) 15. Retaliatory Tax Due [Line 14, Column B (State of Incorporation) minus Line 14, Column A (State of Florida). Enter here and on Page 1, Line 8.]* Need calculation of state of incorporation's insurance premium tax and corporate income tax using Florida premium volume, personnel, and property (attach schedule). Column B State of Incorporation*

Note:

* If zero or less, enter -0-

DR-908 R. 01/09 Page 12

Name _____________________________________ FEIN _________________________________ Taxable Year ______________
SChEDUlE xv FIlINg FEE SChEDUlE

Required Filing Fees
Fraternal Benefit Societies Prepaid limited health All others

Filing Fees Due Per Quarter
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

1st Quarter (Due on 4/15/08) 2nd Quarter (Due on 6/15/08) 3rd Quarter (Due on 10/15/08) 4th Quarter (Due with this return)

0 0 0 $250

0 0 0 $200

$250 $250 $250 $250

Total Filing Fees for the Year. Enter here and on Page 1, Line 9 and Schedule XIV, Line 9, Column A SChEDUlE xvI Type of Policy A. B. Commercial Residential SURChARgE oN CoMMERCIAl/RESIDENTIAl PolICIES 2008 Calendar Year Policies Subject to Surcharge (sum of 4 quarters) Rate X $ 4.00 X $ 2.00 A. B. Surcharge Due

Total Surcharge Due for the Calendar Year (Total A + B). *Enter here and include on Page 1, Line 10 with total from Schedule XVII.

*TheTotalSurchargeDueshouldbegreaterthanthesumofthefirstthreequartersreportedonFormsDR-907.
SChEDUlE xvII PAYMENT DUE FRoM FloRIDA lIFE AND hEAlTh INSURANCe GUARANTY ASSoCIATIoN (FlAhIGA) ReFUND

1. Total Payment Due from FLAHIGA Refunds Received in 2008, If Any, and Previously Claimed as Credit. Enter here and include on Page 1, Line 10 with total from Schedule XVI. See Instructions.

Detach Here

Change of Address or Business Name
Complete this form, sign it, and mail it to the Department if: · Theaddressbelowisnotcorrect. · Thebusinesslocationchanges. · Thecorporationnamechanges. Mail to: FLORIDA DEPARTMENT OF REVENUE 5050 W TENNESSEE ST TALLAHASSEE FL 32399-0100
ChANgE IN New location Address

FEIN of Entity Business Location_________________________________________________________ City____________________________________ State_______ ZIP__________________ Business Telephone (_______) ___________________ County_____________________ In Care of_________________________________________________________________ Mailing Address___________________________________________________________ New Mailing Address City____________________________________ State_______ ZIP__________________ Owner'sTelephone (_______) ___________________ County______________________ New Business DBA______________________________________________________________________ Name New _________________________________________________________________________ Corporation Name

______________________________________________________ Signature of officer (Required) Date

9100 9 20089999 0016045999 0 3999999999 0000 2