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2023 Form M11AR Instructions
Use this form to determine the correct amount of premiums collected for all fire, sprinkler and lightning damage. Use these instructions as a
guide. For further information, see M.S. 297I. The purpose of this form is to collect retaliatory tax on fire insurance premiums.
Be sure to include this form when you file your Form M11.
Filing Requirements
All insurers that write or are authorized to write fire insurance in Minnesota must file Form M11AR if their home state collects a fire insur-
ance tax. This schedule is not required for companies domiciled in Minnesota, Arizona, Hawaii, Massachusetts, New York and Rhode
Island. (M.S. 297I.05, subd. 11)
File Electronically
This schedule (Form M11AR) may be filed electronically using TriTech Software.
Instructions
Check Boxes
At the top of the form, check if the return is:
• an Amended Return: Check only if you are amending a previously filed return for the same period. Include all original and corrected
premiums on the amended return.
• a No Activity Return: Check only if you did not sell any insurance that had fire, lightning or sprinkler leakage coverage for the year.
Line Instructions
Premiums include finance, service or other charges paid to the insurers.
Line 1
Enter all fire premiums written (line 1, Minnesota state page).
Lines 2a and 2b
Enter all crop premiums written for allied lines on line 2a and other than crop premiums on line 2b (line 2.1, Minnesota state page).
Lines 3a and 3b
Enter all farmowners and homeowners multi-peril premiums written (lines 3 and 4, Minnesota state page).
Line 3c
Enter the nonliability portion of all commercial premiums written (line 5.1, Minnesota state page).
Line 3d
Enter the liability portion of all commercial premiums written (line 5.2, Minnesota state page).
Line 4
Enter all inland marine premiums (line 9, Minnesota state page).
Line 5
Enter all ocean marine premiums (line 8, Minnesota state page).
Line 6
Enter all earthquake premiums (line 12, Minnesota state page).
Line 7
Enter all total auto physical damage premiums (lines 21.1 – 21.2, Minnesota state page) OR:
7a. all comprehensive fire, theft and miscellaneous premiums (excluding collision)
7b. all comprehensive fire, theft and miscellaneous premiums with deductibles (excluding collision)
7c. all fire and theft combined premiums
7d. all fire, theft and miscellaneous premiums
7e. all fire premiums
7f. all collision and other premiums
The total auto physical damage premiums listed by breakdown (lines 7a through 7f) should equal total auto physical damage premiums on the
state page of your annual statement.
Line 8
Enter all aircraft physical damage premiums (line 22, Minnesota state page).
Line 9
Include all other premiums collected for your home state’s fire insurance tax if not already included. Provide a breakdown schedule showing
fire portion. For package policies, the fire insurance portion may be broken out to more accurately reflect the correct portion of fire premiums.
Include a schedule detailing the breakdown.
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