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Louisiana Free Printable  for 2022 Louisiana Installment Request for Individual Income

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Installment Request for Individual Income
Form R-19026

R-19026 (9/21) Installment Request for Individual Income Louisiana Department of Revenue Collection Division P.O. Box 66658 Baton Rouge, LA 70896-6658 Telephone: (855) 307-3893 Monthly installments are available to taxpayers who are unable to pay the full balance owed by the due date. During this period, you must submit monthly equal payments of the total balance due. THIS AGREEMENT MUST BE A MINIMUM OF SIX (6) MONTHS AND CANNOT EXCEED 36 MONTHS. How to request an installment agreement To apply for an installment agreement, do not submit this form with your return. Complete pages 2 and 3, and mail the forms to: Louisiana Department of Revenue P. O. Box 66658 Baton Rouge, LA 70896-6658 Any missing or incomplete information will cause the request to be denied. All information will be verified. An initial payment of 20 percent of the amount due is required to complete the request. You may also submit the request by accessing your account at www.revenue.louisiana.gov/latap. Fee for installment agreement There is a fee for an installment agreement of $105. If we approve your request, we will send you a notice detailing the terms of your agreement and will add the installment fee of $105 to the total balance due. However, you will not be charged a fee if your adjusted gross income is less than or equal to $25,000. LDR will let you know whether you qualify for the reduced fee. Note: Do not file this form if you are currently making payments on an installment agreement When to make payments When the installment agreement request has been approved, you will be notified. However, you should make monthly payments even if you have not received a response from the Department. During the existence of this agreement, you must file all state tax returns and pay all state taxes timely. How to make payments We require the use of automatic bank debit for payment of the agreement. With the bank debit, payments will be withdrawn from your checking or savings account on the date you specify. Failure to have sufficient funds in your account at the time of debit will result in an NSF fee being added to the balance due and result in your agreement being cancelled. The application for automatic bank debit is on page 3 of this form. Will I continue receiving bills? The normal billing process will continue. A part of that process is the issuance of a “Notice of Intent”. Failure to make the scheduled monthly payment will result in seizure of bank accounts and/or garnishment of your wages. Please ensure that the last four digits of your social security number is written on your check or money order. An approved installment agreement WILL NOT PREVENT the garnishment of any refund due from the Internal Revenue Service or LDR. To protect the State’s interest, a Tax Assessment and Lien may be filed. What if I miss a payment? If any installment payment is not paid on or before the date fixed for its payment, you will be considered in default of your agreement and the total outstanding balance is immediately due. At this point, all collection actions will be reactivated. You may contact the department to request reinstatement of your installment agreement at which time a reinstatement fee of $60 is due. What if I do not stay current with my taxes and returns? If you do not stay current in your obligations to the state, you will be considered in default of your agreement and the total outstanding balance is immediately due. At this point, all collection actions will be reactivated. You may contact the department to request reinstatement of your installment agreement at which time a reinstatement fee of $60 is due. Contact Information If you have questions about an installment request, contact the Collection Division at (855) 307-3893. If your request is approved, you will need to contact the Collection Division to determine the amount of the final payment since penalty, interest and collection fees will accrue until the tax is paid in full. I R-19026 (9/21) Installment Request for Individual Income Mail to: Louisiana Department of Revenue Collection Division P.O. Box 66658 Baton Rouge, LA 70896-6658 PLEASE PRINT OR TYPE Full Name Social Security Number Home Phone Current Address (number and street) Cell Phone Unit Type Unit Number City State ZIP Employer Date of Hire (mm/dd/yyyy) Employer’s Address Gross Weekly Wage Spouse’s Name Spouse’s Social Security Number Spouse’s Employer Date of Hire (mm/dd/yyyy) Spouse’s Employer Address Gross Weekly Wage Name of Bank (Personal) Bank Account Number Bank Routing Number Name of Bank (Business) Bank Account Number Bank Routing Number Tax periods to be included: Date you wish to make your monthly payments: 1. Total amount due $ 2. Amount of initial payment to be made with application. Multiply Line 1 by 20 percent (.20). $ 3. Balance to be paid over length of agreement. Subtract Line 2 from Line 1. $ 4. Monthly payments. Divide Line 3 by the number of months agreed. Months agreed upon: ___________ $ THIS AGREEMENT MUST BE A MINIMUM OF SIX (6) MONTHS AND CANNOT EXCEED 36 MONTHS. Initial Spouse Initial I/we expressly waive the restrictions and delays prescribed in LA R.S. 47:1562 through 47:1565 and acknowledge that upon execution of this agreement the liabilities identified herein shall become final and immediately collectible. I/we expressly waive any right to appeal or otherwise challenge the liabilities identified herein. I/we expressly waive any right to seek a refund of any amounts paid in connection with this agreement. I/we acknowledge that an approved installment agreement will not prevent the garnishment of any refund due from the IRS or LDR. I/we agree to timely file all returns and pay all taxes that become due and acknowledge that failure to do so will be considered a default under this agreement. Under the penalties of perjury, I declare that I have examined the Request for Payment Arrangement form, including all accompanying documents, and hereby affirm that to the best of my knowledge and belief, it is true, correct, and complete. Your Signature Date (mm/dd/yyyy) Spouse’s Signature Date (mm/dd/yyyy) I R-19026 (9/21) Installment Request for Individual Income Bank Debit Application Name Social Security Number Spouse Name Social Security Number Mail to: Louisiana Department of Revenue Collection Division P.O. Box 66658 Baton Rouge, LA 70896-6658 Daytime Telephone Number Name of your Financial Institution Bank Routing Number Bank Account Number Bank Account Name Start Date (mm/dd/yyyyy) ■ Checking ■ Savings Debit Date (mm/dd/yyyyy) Debit Amount NOTE: PLEASE ATTACH A VOIDED CHECK. Signature and Verification Under penalties of perjury, I (we) declare that the information is to the best of my (our) knowledge and belief is true, correct, and complete. I agree to participate in this Automatic Bank Draft Program. I also authorize the financial institutions involved in processing the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. Your Signature Date (mm/dd/yyyy) Spouse’s Signature Date (mm/dd/yyyy)
Extracted from PDF file 2021-louisiana-form-r-19026.pdf, last modified June 2021

More about the Louisiana Form R-19026 Individual Income Tax TY 2021

We last updated the Installment Request for Individual Income in January 2022, so this is the latest version of Form R-19026, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form R-19026 directly from TaxFormFinder. You can print other Louisiana tax forms here.

Other Louisiana Individual Income Tax Forms:

TaxFormFinder has an additional 34 Louisiana income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form IT-540 Resident Income Tax Return
Form 540-ES Louisiana Estimated Tax Declaration Voucher For Individuals
Form 540V Electronic Filing Payment Voucher
Form IT-540B Nonresident Income Tax Return
Form R-19026 Installment Request for Individual Income

Download all LA tax forms View all 35 Louisiana Income Tax Forms


Form Sources:

Louisiana usually releases forms for the current tax year between January and April. We last updated Louisiana Form R-19026 from the Department of Revenue in January 2022.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Louisiana Form R-19026

We have a total of five past-year versions of Form R-19026 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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