Form R-3406 Fillable Request to Close Business Tax Accounts
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(225) 219 7462 (telephone) (225) 219 0806 (fax) (checkbox) Unchecked (checkbox) Unchecked (text) (text) (text) (text) (text) (text) (text) (text) (text) * Tax accounts other than the types listed above may require additional documentation for closure Please contact the Louisiana Department Account Number Account Number Address Authorization Baton Rouge LA 70821 Close Date (mm/dd/yyyy) Close Date (mm/dd/yyyy) Contact Person Date (mm/dd/yyyy) Daytime Telephone Number I hereby authorize the following account(s) be closed: Legal Name Louisiana Department of Revenue Note: A separate form is not necessary if the change applies to all taxes of Revenue for more information regarding documentation requirements Other *(Specify ) P O Box 201 R 3406 (1/11) Request must be mailed or faxed to: Request to Close Business Tax Accounts Revenue Processing Center Sales Severance Signature State Trade Name Withholding