Louisiana Refund Request of LA Citizens for Property Insurance-Individual
Extracted from PDF file 2019-louisiana-form-r-540ins.pdf, last modified January 2009
Refund Request of LA Citizens for Property Insurance-IndividualR-540INS (1/19) FILING PERIOD Individual Income Tax Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment Your first name MI Last name Suffix If joint return, spouse’s name MI Last name Suffix 2019 Your Social Security Number ➜ Spouse’s Social Security Number ➜ Area code and daytime telephone number Current home address (number and street including apartment number or rural route) ➜ City, town, or APO State ZIP For amended return, mark this box. ➜ Louisiana Revised Statute 47:6025 allows a refundable tax credit equal to 25 percent of the Louisiana Citizens Property Insurance assessment that you paid between January 1, 2019, and December 31, 2019, as a part of your homeowner’s insurance premium. You may claim the Louisiana Citizens Property Insurance Corporation assessment refund on this form or on your individual income tax return, but not on both forms. Claiming the refund on both forms will delay your individual income tax return for review. One Property If you paid the Louisiana Citizens Property Insurance Corporation assessment for only one property, list the property’s address, the insurance company’s name, and the insurance policy number in the boxes below. Enter the amount of your paid assessment below on Line 1. Address of Property Insurance Company Policy Number More Than One Property If you paid the Louisiana Citizens Property Insurance Corporation assessment for more than one property, complete the Supplement Schedule for Refund of Louisiana Citizens Property Assessment, Form R-INS Supplement, and attach it to this return. Enter the total amount of the assessments paid for all properties listed on the Supplement Schedules on Line 1 below. YOU MUST ATTACH A COPY OF YOUR INSURANCE DECLARATION PAGE FOR ALL PROPERTIES. REFUND 1. Enter the amount of the total assessment paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. REFUND - Multiply Line 1 by 25 percent (.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. I also consent that the Louisiana Department of Revenue may contact my insurance company/companies to verify the amount of the Louisiana Citizens Property Insurance Corporation assessment paid, and I further direct my insurance company/ companies to provide the Citizens Insurance Assessment information to the Louisiana Department of Revenue upon request. Your Signature Date (mm/dd/yyyy) Print Preparer’s Name Spouse’s Signature (If filing jointly, both must sign) Preparer’s Signature Date (mm/dd/yyyy) Check PAID PREPARER USE ONLY Firm’s Name ➤ Firm’s FEIN ➤ Firm’s Address ➤ Telephone ➤ MAIL TO: Louisiana Department of Revenue P. O. Box 3576 Baton Rouge, LA 70821-3576 For Office Use Only. Date (mm/dd/yyyy) ■ if Self-employed PTIN, FEIN, or LDR Account Number of Paid Preparer 6977 R-540INS(i) (1/19) Instructions for Preparing your 2019 Louisiana Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment (R-540INS) Mail return to: Louisiana Department of Revenue P. O. Box 3576 Baton Rouge, LA 70821-3576 About this Form The return has been designed for electronic scanning, which permits faster processing with fewer errors. In order to avoid unnecessary delays caused by manual processing, taxpayers should follow the guidelines listed below: 1. An individual may file this form to claim the refund of the Louisiana Citizens Property Insurance Corporation assessment(s) that was paid during calendar year 2019. 2. Enter the amount only on the line that is applicable. 3. Complete the form by using a pen with black ink. 4. Because this form is read by a machine, please enter your numbers inside the boxes like this: 1 2 3 4 5 5. All numbers should be rounded to the nearest dollar. 6. Numbers should NOT be entered over the pre-printed zeros, in the boxes on the far right, which are used to designate cents (.00). 7. If you are filing an amended return, mark an “X” in the “Amended Return” box. 8. Failure to attach the Insurance Declaration Page(s) will result in this form being returned to you. Name(s), address, and Social Security Number(s) – Enter your name(s), address, and Social Security Number(s) in the space provided. If married, please enter Social Security Numbers for both you and your spouse. Information concerning the assessment amounts and Insurance Declaration Page – The amount of this assessment may appear as separate line items on what is referred to as the “Declaration Page” of your property insurance premium notice. The Declaration Page names the policyholder, describes the property or liability to be insured, type of coverage, and policy limits. Depending on the location of the insured property, these line item charges may be listed as: Louisiana Citizens FAIR Plan REGULAR Assessment, Louisiana Citizens FAIR Plan EMERGENCY Assessment, Louisiana Citizens Coastal Plan REGULAR Assessment, and/or Louisiana Citizens Coastal Plan EMERGENCY Assessment. Your total assessment paid is the total of these amounts, if they are shown on the Declaration Page. Important note: If you are a customer of the Louisiana Citizens Insurance Corporation and you paid the Tax Exempt Surcharge, this surcharge may not be claimed. • Enter the address of the property, the insurance company’s name, and the policy number in the spaces provided. • Do you own more than one property that incurred an assessment? If you had more than one property during 2019 that incurred an assessment, prepare and attach Form R-INS Supplement. For more than four properties, use additional R-INS Supplement forms. You must attach the Declaration Page for each property listed. Add all of the assessments that appear on the R-INS Supplement Form, and enter the total on Line 1. 9. Sign and date the return. Mail the return to the address at the top of this form. Paid Preparer Instructions If your return was prepared by a paid preparer, that person must also sign in the appropriate space, complete the information in the “Paid Preparer Use Only” box and enter his or her identification number in the space provided under the box. If the paid preparer has a Preparer Tax Identification Number (PTIN), the PTIN must be entered in the space provided under the box, otherwise enter the Federal Employer Identification Number (FEIN) or LDR account number. If the paid preparer represents a firm, the firm’s FEIN must be entered in the “Paid Preparer Use Only” box. The failure of a paid preparer to sign or provide an identification number will result in the assessment of the unidentified preparer penalty on the preparer. The penalty of $50 is for each occurrence of failing to sign or failing to provide an identification number.
More about the Louisiana Form R-540INS Individual Income Tax TY 2019
We last updated the Refund Request of LA Citizens for Property Insurance-Individual in February 2020, so this is the latest version of Form R-540INS, fully updated for tax year 2019. You can download or print current or past-year PDFs of Form R-540INS directly from TaxFormFinder. You can print other Louisiana tax forms here.
Other Louisiana Individual Income Tax Forms:
|Form Code||Form Name|
|Form IT-540||Resident Income Tax Return|
|Form IT-540B||Nonresident Income Tax Return|
|Form 540V||Electronic Filing Payment Voucher|
|Form R-2867||Transmittal of Federal Extension Request for Louisiana Individual Income Tax Return|
|Form IT-540 Tax Table||Louisiana Tax Table|
Louisiana usually releases forms for the current tax year between January and April. We last updated Louisiana Form R-540INS from the Department of Revenue in February 2020.
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-540INS
We have a total of nine past-year versions of Form R-540INS in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
While we do our best to keep our list of Louisiana Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.