IMPORTANT!
IT-540 WeB
You must enter your SSN below in the same
2013 LOuIsIANA ResIdeNT
order as shown on your federal return.
Mark Box:
Your first name
Init. Last name
Suffix
Name
Your
Change
SSN
If joint return, spouse’s name
Init. Last name
Suffix
Decedent
Spouse’s
Filing
SSN
Present home address
(number and street including apartment number or rural route)
Spouse
Decedent
Area code and daytime telephone number
City, Town, or APO
State
ZIP
Amended
Return
NOL
Carryback
Your Date of Birth
Spouse’s Date of Birth
(mmddyyyy)
(mmddyyyy)
FILING sTATus: Enter the appropriate number in the
6 eXeMPTIONs:
filing status box. It must agree with your federal return.
65 or
Qualifying
X
a “1” in box if single.
6A
Yourself
Blind
Enter
older
Widow(er)
Total of
a “2” in box if married filing jointly.
Enter
6A & 6B
65 or
6B
Spouse
Blind
a “3” in box if married filing separately.
Enter
older
a “4” in box if head of household.
Enter
If the qualifying person is not your dependent, enter name here.
a “5” in box if qualifying widow(er).
Enter
6C dePeNdeNTs – Enter dependent information below. If you have more than 6 dependents, attach a statement to your return with the
6C
required information. Enter the total number from Federal Form 1040A, Line 6c, or Federal Form 1040, Line 6c, in the boxes here.
First Name
Last Name
Social Security Number
Relationship to you
Birth Date
(mm/dd/yyyy)
6D TOTAL eXeMPTIONs – Total of 6A, 6B, and 6C
6d
6451
WeB
64519
66
12312013