Form R-6906a - Corporation Franchise Tax Initial Return

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CFT-4
242
R-6906A (4/12)
State of Louisiana
Department of Revenue and Taxation
PO Box 91011
Baton Rouge, LA 70821-9011
Corporation Franchise
Tax Initial Return
CFT
Louisiana Revenue Account Number
To avoid a penalty , this return must be filed with the
Department of Revenue, PO Box 91011, Baton Rouge,
Name
LA 70821-9011, on or before the 15th day of the third
month following the month in which the tax accrues. If
Number and Street
the due date falls on a holiday or weekend, the return
must be transmitted on or before the next business
City, state, ZIP
day in order to avoid penalty and interest.
1. Per iod covered:
through
2. FEI number
3. Incor porated in state of:
4. Name and address of former owner (If this corporation is successor to an existing business)
5. Name and address of parent cor poration, if applicable
6a. Principal place of business
6b. Telephone number
7a. Pr incipal Louisiana office location (street address and city)
7b. Telephone number
8a. Date Louisiana charter issued
8b. Louisiana charter number (issued by Louisiana Secretary of State)
8c. Date business began in Louisiana
9. Nature of business operation
10. Par ishes in which proper ty is located
11. Name and address of registered agent
$ 10.00
12.
Initial franchise tax .....................................................................................................................
13.
$
Penalty (See instructions.) ...........................................................................................................
14.
$
Interest (See instructions.) .........................................................................................................
Make payment to:
Louisiana Department of Revenue and Taxation
15.
$
Total amount due ..................................................................................................................................................................
Do NOT send cash.
Signature of verification
I declare under the penalties for filing false retur ns that this return has been examined by me, and is, to the best of my
knowledge and belief, true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of
which he has any knowledge.
Signature of officer
Title
Date
Telephone
Individual or firm signature of preparer
Date
Telephone

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