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Name and Address Required Amended Return Surplus Lines Report for Month of /20 NAIC FEIN Total premiums assessments and other charges assessments and other charges collected on risk located in Kentucky exclude municipal taxes and finance and service charges. 1a b Finance and service charges. 1b c Total add lines 1a and 1b. 2. Less amounts not subject to surcharge a* Premiums returned to policyholders on terminated policies on policies with payments received after 3/31/10. 2a b. Premiums coll ...

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