Form It-540b Web - Louisiana Nonresident And Part-Year Resident - 2014 Page 4

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IT-540B WEB

(Page 4 of 4)

Enter your Social Security Number.

AMOUNT YOU OWE – If Line 19 is greater than Line 29, subtract Line 29 from Line 19.

AddITIONAL dONATION TO THE MILITAry FAMILy ASSISTANCE FUNd

AddITIONAL dONATION TO THE COASTAL PrOTECTION ANd rESTOrATION FUNd

AddITIONAL dONATION TO THE NATIONAL MULTIPLE SCLErOSIS

SOCIETy FUNd

AddITIONAL dONATION TO LOUISIANA FOOd BANK ASSOCIATION

AddITIONAL dONATION TO THE SNAP FrAUd ANd ABUSE dETECTION ANd PrEVENTION FUNd

INTEREST – From the Interest Calculation Worksheet, page 29, Line 5.

DELINqUENT FILING PENALTY – From the Delinquent Filing Penalty Calculation Worksheet, page 29, Line 7.

DELINqUENT PAYMENT PENALTY – From Delinquent Payment Penalty Calculation Worksheet, page 29, Line 7.

UNDERPAYMENT PENALTY – See instructions for Underpayment Penalty, page 29, and

Form R-210NR. If you are a farmer, check the box.

BALANCE DUE LOUISIANA – Add Lines 37 through 46. If mailing to

PAy THIS AMOUNT.

LDR, use address 1 below. For electronic payment options, see page 2.

IMPOrTANT

dO NOT SENd CASH.

All four (4) pages of this return

MUST be mailed in together along

with your W-2s and completed

schedules. Please paperclip.

do not staple.

I declare that I have examined this return, and to the best of my knowledge, it is true and complete. Declaration of paid preparer is based on all available information. If I made a

contribution to the START Savings Program, I consent that my Social Security Number may be given to the Louisiana Office of Student Financial Assistance to properly identify the

START Savings Program account holder. If married filing jointly, both Social Security Numbers may be submitted. I understand that by submitting this form I authorize the disburse-

ment of individual income tax refunds through the method as described on Line 36.

Your Signature

Date

Signature of paid preparer other than taxpayer

Spouse’s Signature (If filing jointly, both must sign.)

Date

Telephone number of paid preparer

Date

(

)

Enter the first 4 characters of your

last name in these boxes.