Form L-3 - Annual Reconciliation
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1
2ANNUAL RECONCILIATION FORM L-3
Louisiana Department of Revenue
,
,
P.O. Box 91017, Baton Rouge, LA 70821-9017
20
Mark box if
IMPORTANT: All filers must complete the
1 Gross
0 0
amended
front and back of this form.
payroll
return.
for year
Withholding Tax
,
,
Account Number
Please mark method of filing:
2 Tax
0 0
Filing deadline (or within 30
previously
days after last month
remitted
wages were paid)
For office use only
Mark box if address
W-2
3 # of W-2s attached or employees
has changed.
CFS
Tape
Disk
reported on magnetic media
,
,
4 Total
0 0
tax per
W-2s
Field
Flag
TAX YEAR
(
)
Signature
Title
Date
Telephone
Under the penalties of perjury, I declare that I have examined this return, including all accompanying
documents, and to the best of my knowledge and belief, it is true, correct, and complete.
Do not send payment with this report.
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Parent category: Financial