(checkbox) Unchecked
(checkbox) Unchecked
(mm/dd/yyyy)
(mm/dd/yyyy)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(YYYY)
(YYYY)
19059250Legal Name
19059250Legal Name
19059250Legal Name
19059250Legal Name
Address
Address
Address
Address
Amount of payment DO NOT SEND CASH
Amount of payment DO NOT SEND CASH
Baton Rouge LA 70821 9011
Baton Rouge LA 70821 9011
City State ZIP
City State ZIP
City State ZIP
City State ZIP
CLouisiana Revenue Account Number Federal Employer Identification Number Payment due date Corporation
CLouisiana Revenue Account Number Federal Employer Identification Number Payment due date Corporation
CLouisiana Revenue Account Number Federal Employer Identification Number Payment due date Corporation
CLouisiana Revenue Account Number Federal Employer Identification Number Payment due date Corporation
For office use only
For office use only
For office use only
For office use only
If year end differs from prior year mark box For calendar year 2014 or fiscal year ending
If year end differs from prior year mark box For calendar year 2014 or fiscal year ending
Louisiana Department of Revenue
Louisiana Department of Revenue
LOUISIANA ESTIMATED TAX DECLARATION VOUCHER FOR CORPORATIONS 2014
LOUISIANA ESTIMATED TAX DECLARATION VOUCHER FOR CORPORATIONS 2014
Mail date
Mail date
Mail date
Mail date
Name or address changes and payments can be made at www revenue louisiana gov/latap
Name or address changes and payments can be made at www revenue louisiana gov/latap
PO Box 91011
PO Box 91011
To ensure proper credit please DO NOT fold or staple Mail this form with your payment to:
To ensure proper credit please DO NOT fold or staple Mail this form with your payment to:
Trade Name
Trade Name
Trade Name
Trade Name
Voucher 1
Voucher 2
Voucher 3
Voucher 4
yearCIFT 620ES (2014) WEB
yearCIFT 620ES (2014) WEB
You can pay your estimated tax at www revenue louisiana gov/fileonline
You can pay your estimated tax at www revenue louisiana gov/fileonline