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Area code and daytime MAIL TO Louisiana Department of Revenue P. O. Box 3576 Baton Rouge LA 70821-3576 Instructions for Preparing Your 2012 Louisiana Request for Refund of Louisiana Assessment R-540INS This space at the bottom of the form is to be used only when specifically instructed by LDR. Otherwise leave blank. R-540INS 1/12 Your first name MI Last name FILING PERIOD Individual Income Tax Request for Refund of Louisiana Citizens Property Ins.

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