Form R-20127-L - Claim For Refund Of Taxes Paid - Louisiana Department Of Revenue - 1998

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State of Louisiana
R-20127-L (2/98)
Department of Revenue
Claim for Refund of Taxes Paid
To be filed with the Secretary of Revenue, Baton Rouge, Louisiana
Make separate claim for each overpayment of tax and for each period.
Louisiana Account Number _______________________
Type of tax ___________________________________
Period _______________________________________
Name of taxpayer _________________________________________________________________________________
If taxpayer is corporation, enter corporation name.
Represented by ___________________________________________________________________________________
Give name and title.
Address _________________________________________________________________________________________
City, State, ZIP ___________________________________________________________________________________
(
)
Telephone _______________________________________________________________________________________
Total amount paid for period
$ ___________________________
Amount claimed to be due
$ ___________________________
Amount now requested to be refunded
$ ___________________________
This refund is claimed for the following reasons:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Attach additional sheets, if necessary.
_______________________________________________________________
_____________________________
Taxpayer signature
Date

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