Form R-540v - Individual Income Tax Electronic Filing Payment Voucher
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Complete Form R-540v - Individual Income Tax Electronic Filing Payment Voucher with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1R-540V (9/05)
Individual Income Tax Electronic
Filing Payment Voucher
Louisiana Department of Revenue
P.O. Box 3550
Baton Rouge, LA 70821-3550
Important notice
Tax preparers should provide this form to clients who file electronically if a payment is due with the return. Taxpayer clients
who owe additional Louisiana individual income tax for 2005 must complete the payment voucher at the bottom of this page,
detach and mail by May 15, 2006, in order to avoid the assessment of penalties and interest. The top portion of this form
should also be completed and retained by the taxpayer as a record of payment.
DO NOT SEND CASH.
Complete and retain this portion as a record of payment.
You can also make payments via the internet.
Go to
Name
Street
City
State
ZIP
In order as listed on tax return
Your Social Security Number (1)
Amount of payment
Spouse’s Social Security Number (2)
Check Number
Date Sent
Detach and submit the voucher below with your payment by May 15, 2006.
Individual Income Tax Electronic Filing Payment Voucher
R-540V 05
Name
Print in order as listed above.
E
Address
Your Social Security Number (1)
City, State, ZIP
Your spouse's Social Security Number (2)
AMOUNT
Make payment to:
ENCLOSED
Louisiana Department of Revenue
Please include your Social Security
P. O. Box 3550
Number on your payment.
Baton Rouge, LA 70821-3550
Do not send cash.
Mail date
6560
For office use only.
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