Form R-6002 - Direct Deposit Application For Individual Income Refund - 2006
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1R -6002 (1/06)
Direct Deposit Application
For Individual Income Refund
Request must be mailed to:
Louisiana Department of Revenue
Attn: Taxpayer Service Division
Post Office Box 66362
Baton Rouge, La 70896-6362
Fax number: (225) 219-2446
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Please print or type.
Tax Year:
2004 or
2005
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Name
Social Security Number
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Spouse Name
Social Security Number
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Daytime Telephone Number
Name of your Financial Institution
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Bank Routing Number
Bank Account Number
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Bank Account Name
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Checking
Savings
Routing Transit Number: A 9-digit number that identifies your bank. For checking accounts, the RTN appears as the first
group of numbers at the bottom of your check.
Account Number: The account number for your savings or checking account. For checking accounts, this is the second
group of numbers at the bottom of your check. Be careful not to include the check number, which is the last group of num-
bers at the bottom of a check.
This one time authorization is valid for this refund only. A new form must be completed for any additional and sub-
sequent refund requests.
Signature and Verification
Under penalties of perjury, I (we) declare that the information is to the best of my (our) knowledge and belief is true,
correct, and complete. I also authorize the Louisiana Department of Revenue to transfer my individual income tax refund
for the taxable year ending ______________________, or fiscal year ended ________________________ to the bank account
referenced above.
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Your signature
Date
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Spouse’s Signature
Date
Requests sent to us by mail or fax must attach a copy of the driver’s license of each taxpayer.
Primary Drivers License Copy
Spouse’s Drivers License Copy
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Parent category: Financial