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Form R-6464 - Application For Extension Of Time To File Louisiana Team Composite Income Tax Return

R-6464 (1/10)

Application for Extension of Time

to File Louisiana Team Composite

Income Tax Return

Louisiana Department of Revenue

P.O. Box 4998

Baton Rouge, LA 70821-4998

SPEC

The space at the bottom of this form is to be used only when specifically instructed by LDR. Otherwise, leave

CODE

blank.

For calendar year filers, complete and submit the form below before May 15, 2010, to extend the date to file your Louisiana Team

Composite Income tax return until November 15, 2010.

For fiscal year filers, please indicate the fiscal period below when requesting your 6-month extension to file your Louisiana Team

Composite Income tax return. The due date for fiscal filers is the fifteenth day of the fifth month after the close of the fiscal year.

By filing this extension, you are requesting only an extension of time to file. This form does not grant an extension of time to pay the tax

due. Payments received after the return due date will be charged interest and late payment penalty.

You may be able to file your extension on our website at

Louisiana Team Composite Extension

Print your total Louisiana income tax liability for the tax year ended December 31,

2009, or the fiscal year ended ________, _______. (

.00

You may estimate this amount.)

Print the total amount of Louisiana payments. (Include amounts of tax withheld, declara-

tion/estimated payments, and overpayments carried forward from the previous year.)

.00

Print income tax balance due.

(Subtract Line 2 from Line 1. If Line 2 is greater than Line 1, enter zero “0.”)

.00

Detach and submit the voucher below with your payment

✁

R-6464 (1/10)

For calendar year ended 2009, or other tax year beginning ___________, 2009, ending ____________, 2010.

Louisiana Application for Extension of Time to File Louisiana Team Composite Return

Team Name

Louisiana Revenue Account Number

Address

Tax Period

City

State

ZIP

Mail this form with your payment to:

Amount

.00

DO nOT SEnD CASh.

Louisiana Department of Revenue

enclosed

P.O. Box 4998

Baton Rouge, LA 70821-4998

I request an extension of time until _________, _____ to file a Louisiana Team Composite

Income tax return for the calendar year _____ or fiscal year ending _________, _____.

1907

SPEC

CODE

19075

Form R-6464 - Application For Extension Of Time To File Louisiana Team Composite Income Tax Return

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