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Y Number Print Spouse s Social Security Number If name or address is incorrect, make necessary changes. You can pay your estimated tax at www.revenue.louisiana.gov. To ensure proper credit, please DO NOT fold or staple. Mail this form with your payment to: Louisiana Department of Revenue PO BOX 91007 Name Baton Rouge LA 70821-9007 Spouse s Name Address City, State, ZIP Spec Code Payment due date $ Amount of payment. 665 DO NOT SEND CASH. .00 Mark box if address has changed. Mail d.
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