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Insurance Premiums Tax Return Nonresident and Foreign Companies See instructions on back before completing this application. Complete this form in blue or black ink only. Do not use staples. Type or print. Name of company Connecticut Tax Registration Number Number and street PO Box City, town, or post office State ZIP code Federal Employer ID Number (FEIN) This is not an extension of time to pay your tax. Penalties and interest may apply. See instructions. I request a 12 mo.
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