Payment Distribution Voucher Template
Download a blank fillable Payment Distribution Voucher Template in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Payment Distribution Voucher Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
18401 United Plaza Blvd, Ste 300 • Baton Rouge, LA 70809-7017
Form 4D (09/13)
P.O. Box 94123 • Baton Rouge, LA 70804-9123
Telephone: (225) 925-6446 • Fax: (225) 925-4258
•
Payment Distribution Voucher
Employer ID _________________ Employer Name _______________________________________________________________________
Total remitted ________________________________________ (Amount must equal total contributions in blocks below.)
REGULAR PLAN
OPTIONAL RETIREMENT PLAN (ORP)
Apply to Mo/Yr
Type
Contributions
Apply to Mo/Yr
Type
Contributions
Current Year
Current Year
1. ____ / __________ S - Member $___________________
1. ____ / __________ S - Member $___________________
2. ____ / __________ U - Member $___________________
2. ____ / __________ U - Member $___________________
3. ____ / __________ -- Employer
$___________________
3. ____ / __________ -- Employer
$___________________
4. ____ / __________ I - Employer $___________________
4. ____ / __________ I - Employer $___________________
Prior Year
Prior Year
S - Member $___________________
S - Member $___________________
U - Member $___________________
U - Member $___________________
-- Employer $___________________
-- Employer $___________________
I - Employer $___________________
I - Employer $___________________
TOTAL
TOTAL
$___________________
$___________________
PLAN A
PLAN B
Apply to Mo/Yr
Type
Contributions
Apply to Mo/Yr
Type
Contributions
Current Year
Current Year
1. ____ / __________ S - Member $___________________
1. ____ / __________ S - Member $___________________
2. ____ / __________ U - Member $___________________
2. ____ / __________ U - Member $___________________
3. ____ / __________ -- Employer
$___________________
3. ____ / __________ -- Employer
$___________________
4. ____ / __________ I - Employer $___________________
4. ____ / __________ I - Employer $___________________
Prior Year
Prior Year
S - Member $___________________
S - Member $___________________
U - Member $___________________
U - Member $___________________
-- Employer $___________________
-- Employer $___________________
I - Employer $___________________
I - Employer $___________________
TOTAL
TOTAL
$___________________
$___________________
Apply to Mo/Yr - Actual month/year for which the contribution payments are being made.
Type - S = Sheltered; U = Unsheltered; I = Interest (Sheltered and Unsheltered applies only to members’ contributions.)
Line 1 - Members’ total Sheltered contributions must be entered on this line.
Line 2 - Members’ total Unsheltered contributions must be entered on this line.
Line 3 - Employers’ share of contributions must be entered on this line.
Line 4 - Interest for delinquent payments of contributions must be entered on this line.
Prior Year - If Prior Year, allocate amounts for each contribution type. No month/year classification is required.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Life