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Get For Calendar Year 2021 Or Fiscal Year Ending

Y Number Spouse s Social Security Number Address changes and estimated tax payments can be made at www.revenue.louisiana.gov/latap. To ensure proper credit, please DO NOT fold or staple. Mail this form with your payment to: Louisiana Department of Revenue P.O. Box 91007 Baton Rouge LA 70821-9007 Payment Due Date $ Amount of payment Name Spouse s Name Address City, State ZIP 600 12312021 (DO NOT SEND CASH) .00 Mail date 19059 Individual Voucher 1 For office use only 1905 LOUIS.

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