Form R-20130 Fillable Request for Compromise of Interest
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(text) (text) (text) (text) (text) A complete record of all amounts compromised shall be maintained by the secretary shall be open to public inspection and shall be According to Louisiana Revised Statute 47:1601(A)(2)(d) and subject to the conditions of Louisiana Administrative Code 61:III 2115 B a All outstanding taxes have not been paid Amount of Interest Compromised Amount of Interest to be compromised Approved Disapproved Baton Rouge LA 70896 6658 considered if any of the following apply: Department Representative Approval Date FOR OFFICIAL USE ONLY including all accompanying documentation are true correct and complete Louisiana Department of Revenue Louisiana Revenue Account ID Number P O Box 66658 PLEASE PRINT OR TYPE published in the Department s annual report R 20130 (1/08) Request for Compromise of Interest Request is hereby made to compromise the amount of interest based on the following reasons: request may be made to compromise the amount of interest to be added to the amount of tax due A request for compromise will NOT be Signature of Authorized Representative Date (mm/dd/yyyy) Tax Period(s) Tax Type Taxpayer Name Taxpayer s Authorized Representative The interest accrued as a result of participation in an abusive tax avoidance transaction The interest accrued on taxes that were collected on behalf of the state but not remitted The taxpayer has had any interest compromised in the last five years The taxpayer his affiliates or related entities have had interest compromised for the same issue The taxpayer is party to a voluntary disclosure agreement for the same period There is a binding judicial decision regarding the issue Title Under penalty of perjury I declare all of the facts provided above as a basis for a compromise to the best of my knowledge and belief