Form R-3406 - Request To Close Business Tax Accounts
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1R-3406 (1/11)
Request to Close Business Tax Accounts
Request must be mailed or faxed to:
Louisiana Department of Revenue
Revenue Processing Center
P.O. Box 201
Baton Rouge, LA 70821
(225) 219-7462 (telephone)
(225) 219-0806 (fax)
Note: A separate form is not necessary if the change applies to all taxes.
Legal Name
Trade Name
Address
City
State
ZIP
I hereby authorize the following account(s) be closed:
Account Number
Close Date
(mm/dd/yyyy)
■
Sales
Account Number
Close Date
(mm/dd/yyyy)
■
Withholding
Account Number
Close Date
(mm/dd/yyyy)
■
Severance
Account Number
Close Date
(mm/dd/yyyy)
■
Other *
_________________________________________
(Specify)
* Tax accounts other than the types listed above may require additional documentation for closure. Please contact the Louisiana De-
partment of Revenue for more information regarding documentation requirements.
Authorization
Contact Person
Daytime Telephone Number
Signature
Date
(mm/dd/yyyy)
X
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Parent category: Financial