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Get Form T-71A - Rhode Island Division Of Taxation - Tax Ri

NAME ADDRESS CITY STATE ZIP CODE FEDERAL EMPLOYER IDENTIFICATION NUMBER/SOCIAL SECURITY NUMBER E-MAIL ADDRESS STATE OR COUNTRY OF INCORPORATION OR ORGANIZATION BROKER LICENSE NUMBER Computation of Tax 1. Gross premium charged ......................................................................................................... 1. 2. Returned Premiums ................................................................................................................ 2. 3. Net Taxable Premium.

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