Form R-540v - Individual Income Tax Electronic Filing Payment Voucher - Louisiana Department Of Revenue

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R-540V (1/08)
Individual Income Tax Electronic
Filing Payment Voucher
Louisiana Department of Revenue
P.O. Box 3550
Baton Rouge, LA 70821-3550
IMPORTANT NOTICE
Tax preparers should provide this form to clients who file electronically if a payment is due with the return.
Taxpayer clients who owe additional Louisiana individual income tax for 2007 must complete the payment
voucher at the bottom of this page, detach and mail by May 15, 2008, in order to avoid the assessment of
penalties and interest. The top portion of this form should also be completed and retained by the taxpayer as
a record of payment.
• DO NOT SEND CASH.
•
Complete and retain this portion as a record of payment.
• You can also make payments via the internet. Go to
Name
Address
City
State
ZIP
In order as listed on tax return
Your Social Security Number (1)
A m o u n t o f p a y m e n t
Your spouse's Social Security Number (2)
Check Number
Date Sent
Detach and submit the voucher below with your payment by May 15, 2008.
INDIVIDUAL INCOME TAX ELECTRONIC FILING PAYMENT VOUCHER
E
PLEASE PRINT OR TYPE.
Name
Address
City
State
ZIP
Amount of payment.
DO NOT SEND CASH.
$
Print in order as listed above.
•
Make payment to:
Your Social Security Number (1)
Please include your Social Security
Louisiana Department of Revenue
Number on your payment.
P. O. Box 3550
Your spouse's Social Security Number (2)
Baton Rouge, LA 70821-3550
Do not send cash.
Mail date
1903
For office use only.
1 9 0 3 4
6 6 3
1 2 3 1 2 0 0 7

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