La Form 8453ol - Louisiana Individual Income Tax Declaration For Electronic Filling (2006)
ADVERTISEMENT
1Louisiana
R-8453OL (1/07)
LA 8453OL
Individual Income Tax Declaration for Electronic Filing
0 0 0 0
7 7
-
-
-
IRS DCN
Your first name and initial (If joint return, also give spouse’s name and initial.)
Last name
Your Social
1
Security
Number
Spouse’s first name and initial.
Last name
Spouse’s
2
Social Security
2006
Number
Present home address (number and street including apartment number or rural route)
Daytime
Telephone
Number
City, town, or post office
State
ZIP
Part A
Tax Return Information
,
,
.
,
,
.
Balance Due
Refund due
00
00
Direct Deposit of Refund (Optional) ❑ or Direct Debit (Optional) ❑
Part B
Routing Number The first 2 digits of the routing
number must be 01 through 12 or 21 through 32.
Direct Debit Payment
,
,
.
00
Account Number
Withdrawal Date
MM
DD
YY
❑
❑
❑
❑
Full Payment
Partial Payment
Type of Account:
Checking
Savings
(Check one.)
❑
Payment made/will be made by credit card.
PART C
Declaration of Taxpayer
❑
I consent that my refund be directly deposited as designated in Part B, and declare that the information shown in Part B is correct. If
I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.
❑
I do not want direct deposit of my refund or am not receiving a refund.
❑
I authorize the Louisiana Department of Revenue and its designated Financial Agent to initiate an ACH electronic funds withdrawal
(direct debit) entry to the financial institution account indicated in Part B for payment of my State taxes owed on this return. I also
authorize the financial institutions involved in processing the electronic payment of taxes to receive confidential information neces-
sary to answer inquiries and resolve issues related to the payment.
I understand that if I have filed a balance due return and if the Louisiana Department of Revenue does not receive full and timely
payment of my tax liability, I will remain liable for the tax liability and all applicable interest and returns.
I declare that I have examined my state income tax return prepared for electronic transmission to the State of Louisiana and, to
the best of my knowledge and belief, it is true and complete.
Please sign here. ____________________________
__________
____________________________
______________
Your signature
Date
Spouse’s signature (if joint return)
Date
Do Not Mail
You must retain this form along with the state copy of your supporting
W2s and 1099s for a minimum of 3 years. DO NOT MAIL.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial