Form It-540b - Louisiana Nonresident And Part-Year Reside - 2013 Page 4
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10PLEASE PAPERCLIP W-2S AND SCHEDULES
Enter your Social Security Number.
2013 LOuISIANA REFuNDABLE CHILD CARE CREDIT – Your Federal Adjusted Gross Income must
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be EQUAL TO OR LESS THAN $25,000 to claim the credit on this line. See instructions, page 22 and
Refundable Child Care Credit Worksheet.
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20A Enter the qualified expense amount from the Refundable Child Care Credit worksheet, Line 3.
20B
20B Enter the amount from the Refundable Child Care Credit worksheet, Line 6.
2013 LOuISIANA REFuNDABLE SCHOOL READINESS CREDIT - Your Federal Adjusted Gross Income
must be EQUAL TO OR LESS THAN $25,000 to claim the credit on this line. See Refundable School
Readiness Credit Worksheet.
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LOuISIANA CITIZENS INSuRANCE CREDIT
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OTHER REFuNDABLE TAx CREDITS – From Schedule F–NR, Line 7
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AMOUNT OF LOUISIANA TAX WITHHELD FOR 2013 – Attach Forms W-2 and 1099.
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AmOuNT OF CREDIT CARRIED FORwARD FROm 2012
AmOuNT PAID ON YOuR BEHALF BY A COmPOSITE PARTNERSHIP FILING
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Enter name of partnership.
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AmOuNT OF ESTImATED PAYmENTS FOR 2013
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AmOuNT PAID wITH ExTENSION REquEST
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TOTAL REFuNDABLE TAx CREDITS AND PAYmENTS – Add Lines 20, and 21
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through 28. Do not include amounts on Line 20A and 20B.
OvERPAYmENT – If Line 29 is greater than Line 19, subtract Line 19 from Line 29. Your
overpayment may be reduced by Underpayment of Estimated Tax Penalty. Otherwise,
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go to Line 37.
uNDERPAYmENT PENALTY – See instructions for Underpayment Penalty, page 29
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and Form R-210NR. If you are a farmer, check the box.
ADjuSTED OvERPAYmENT – If Line 30 is greater than Line 31, subtract Line 31 from Line 30. If Line 31 is
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greater than Line 30, subtract Line 30 from Line 31, and enter the balance on Line 37.
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TOTAL DONATIONS – From Schedule D-NR, Line 26
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SuBTOTAL – Subtract Line 33 from Line 32 to determine the amount of overpayment available for credit
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or refund.
CREDIT
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AmOuNT OF LINE 34 TO BE CREDITED TO 2014 INCOmE TAx
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AmOuNT TO BE REFuNDED – Subtract Line 35 from Line 34. If mailing to LDR, use Address 2 on the next page.
Enter a “1” in box if you want to receive your refund on a myRefund card.
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REFUND
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Enter a “2” in box if you want to receive your refund by paper check.
Enter a “3” in box if you want to receive your refund by direct deposit. Complete
information below. If information is unreadable, or if you do not make a refund selection,
you will receive your refund on a myRefund Card.
DIRECT DEPOSIT INFORMATION
will this refund be forwarded to a financial
Type:
Checking
Savings
institution located outside the united States?
Yes
No
Routing
Account
Number
Number
COMPLETE AND SIGN RETURN ON NEXT PAGE
Enter the first
4 characters of
your last name
6484
WEB
in these boxes.
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