M29_ Auto Theft Prevention Surcharge Payment voucher

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					2010 Auto Theft Prevention Surcharge                                                                                                                                                   M29

  IMPORTANT: Type in the required information while this form is on the screen and print a copy. A personalized scan
  line will be printed on the voucher using the information you entered. To help ensure your payment is properly credited
  to your account, verify that the period end date and Minnesota tax ID number are included in the scan line.
  When you print this voucher, be sure to set the Page Scaling to “None” in your Print options. DO NOT check the “Auto-
  rotate and center pages” or “Shrink to fit” boxes. If they are already checked, click on the box to uncheck them.

Companies licensed for auto insurance are                            for a Minnesota tax ID number” on the                                 Pay by credit card
required to pay an auto theft prevention                             e-Services menu. If you don’t have Internet                           •	 Go	to,	or
surcharge. To calculate the surcharge, multiply                      access, call 651-282-5225 or 1-800-657-3605.                          •	 Call	1-800-272-9829.	
the number of insured vehicles with com-
prehensive insurance coverage by $0.50 per                           Pay electronically                                                    You will be charged a fee to use this service,
vehicle for six months of coverage. Include the                      •	 Go	to,	click	“Login	                         which goes directly to Official Payments
following types of vehicles: passenger automo-                          to e-File Minnesota” on the e-Services                             Corporation	(a	national	company	that	
biles, pickup trucks, vans (but not commuter                            menu and follow the prompts for a busi-                            partners with federal, state and local gov-
vans), and motorcycles.                                                 ness to make an auto theft prevention                              ernments to provide credit card payment
                                                                        surcharge payment, or                                              services). The Department of Revenue does
If you have questions, call 651-297-1772. TTY                                                                                              not have any financial agreement with Of-
users: Call 711 for Minnesota Relay.                                 •	 Call	1-800-570-3329	to	pay	by	phone.
                                                                                                                                           ficial Payments and does not receive any of
                                                                     For both methods, you’ll need your Minne-                             its fees.
Due dates                                                            sota tax ID number, password and banking
Your quarterly payments are due May 1,                               information. When paying electronically,                              Pay by check
August 1, November 1 and February 1 of the                           you must use an account not associated with                           If you are not required to pay electroni-
following year. If there is zero surcharge for                       any foreign banks.                                                    cally,	you	may	pay	by	check.	Complete	the	
the period, there is nothing you need to do.                                                                                               voucher below and mail it with your check.
                                                                     Note: If you’re using e-File Minnesota for the
When the due date falls on a Saturday,                               first time and you need a temporary pass-                             All information is required to process your
Sunday or legal holiday, payments elec-                              word, call our Business Registration Office at                        payment, including your Minnesota tax ID
tronically made or postmarked on the next                            651-282-5225 or 1-800-657-3605.                                       number.
business day are considered timely.                                                                                                        When you pay by check, your check autho-
                                                                     After you authorize the payment, you’ll re-
                                                                     ceive a confirmation number. You can cancel                           rizes us to make a one-time electronic fund
Before a payment can be made                                         a payment up to one business day before the                           transfer from your account, and you may
To ensure your payment is processed cor-                                                                                                   not receive your canceled check.
rectly, you must have a Minnesota tax ID                             scheduled payment date, if needed.
number. To register, go to our website at                            Do not send in the voucher below unless and click “Register                            you are paying by check.

(Rev. 12/10)                                                      Cut carefully along this line to detach.

                     If there is zero surcharge for the period, there is nothing you need to do. Do not send the voucher.

                                                                                             M29                                                                                        501
Auto Theft Prevention Surcharge                                                                     Minnesota tax ID
Name of insurance company

Mailing address
                                                                                                        NAIC number
                                                                                                                            Enter the last day of the period. Example:
                                                                                                                            If making a 2011 payment, enter 033111
City                                                     State       Zip code
                                                                                                                            for Period 1; 063011 for Period 2; 093011
                                                                                                     Period end date
                                                                                                                            for Period 3; or 123111 for Period 4.

Make check payable to Minnesota Revenue and mail to:                                                         AMOUNT
Minnesota Revenue, Mail Station 1780, St. Paul, MN 55145-1780                                               OF CHECK                                                                     00
   w    To help ensure your payment is properly credited to your account, be sure to verify that the scan line below includes the correct period end date and your Minnesota tax ID.

       5010000000000000000000123110000000                                                                           0000000000000000000000002

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