Instructions For Form R-540ins - Preparing Request For Refund printable pdf download

R-540INS (1/07)

Instructions for Preparing Your 2006

Louisiana Request for Refund of Louisiana

Citizens Property Insurance Corporation

Assessment (R-540INS)

ABOUT THIS FORM

The return has been designed for electronic scanning, which permits faster processing with fewer errors. In order to avoid

unnecessary delays caused by manual processing, taxpayers should follow the guidelines listed below:

1. You may file this form to claim your refund of the Louisiana Citizens Property Insurance Corporation assessment(s) that

you paid during calendar year 2006 only if you are not required to and do not file a Louisiana income tax return.

2. Print amounts only on those lines that are applicable.

3. Use only a pen with black ink.

1 2 3 4

4. Because this form is read by a machine, please print your numbers inside the boxes like this:

5. All numbers should be rounded to the nearest dollar.

6. Numbers should NOT be printed over the pre-printed zeros, in the boxes on the far right, which are used to designate

cents (.00).

7. To avoid any delay in processing, you can only use this form for 2006.

8. Failure to attach the Insurance Declaration Page(s) will result in this form being returned to you.

Name(s), address, and Social Security Number(s) – Print your name(s), address, and Social Security Number(s) in the

space provided. If married, please print Social Security Numbers for both you and your spouse.

Information concerning the assessment amounts and Insurance Declaration Page – The amount of this assessment

may appear as separate line items on what is referred to as the “Declaration Page” of your property insurance premium

notice. The Declaration Page names the policyholder, describes the property or liability to be insured, type of coverage, and

policy limits. Depending on the location of the insured property, these line item charges may be listed as: Louisiana Citizens

FAIR Plan REGULAR Assessment, Louisiana Citizens FAIR Plan EMERGENCY Assessment, Louisiana Citizens Coastal

Plan REGULAR Assessment, and/or Louisiana Citizens Coastal Plan EMERGENCY Assessment. Your total allowable

credit is the sum of these amounts, if they are shown on the Declaration Page.

Line 1 – Print the address of the property, the insurance company’s name, and the policy number in the spaces provided.

Print the amount of the paid assessment in the appropriate boxes.

Line 2 – Do you own more than one property that incurred an assessment?

If you had more than one property during 2006 that incurred an assessment, prepare and attach Form R-INS Supplement.

You must attach the Declaration Page for each property listed. Print on Line 2 the total of the additional assessments list-

ed on the Form R-INS Supplement.

Line 3 – Add the assessment amounts that appear on Lines 1 and 2.

Sign and date the return. Mail to:

Louisiana Department of Revenue

P. O. Box 3576

Baton Rouge, LA 70821-3576.

6766

Instructions For Form R-540ins - Preparing Request For Refund