Louisiana Free Printable  for 2017 Louisiana Request for Refund of LA. Citizens Property Insurance

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Request for Refund of LA. Citizens Property Insurance
Form R-620INS

R-620INS (1/17) FILING PERIOD Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment ➜ ➜ ➜ ➜ 2017 Corporation or Nontaxable Entity Louisiana Revenue Account Number Legal Name Trade Name If you DO NOT have a Louisiana Revenue Account Number, mark this box. Address City 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 was paid by a corporation or a nontaxable entity between January 1, 2017, and December 31, 2017 as a part of its property insurance premium. You may claim the Louisiana Citizens Property Insurance Corporation assessment refund on this form or on the entity’s income tax return, but not on both forms. Claiming the refund on both forms will delay the income tax return for review. One Property If the corporation or nontaxable entity 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 the paid assessment below on Line 1. Address of Property Insurance Company’s Name Policy Number More Than One Property If the corporation or nontaxable entity 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 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 Calculate the Refund of Louisiana Citizens Property assessment below. Act 9 of the 2016 Second Extraordinary Session of the Louisiana Legislature reduced the credit to 25% of the assessment paid. 1. Enter the amount of the total assessment paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Multiply Line 1 by 25 percent (.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he 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. Enter name of officer Signature of preparer Signature of officer Firm name Title of officer Date (mm/dd/yyyy) Telephone Telephone Date (mm/dd/yyyy) SPEC CODE Area code and daytime telephone number MAIL TO: Louisiana Department of Revenue P. O. Box 3576 Baton Rouge, LA 70821-3576 2650 R-620INS(i) (1/17) Instructions for Preparing Your 2017 Louisiana Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment (R-620INS) SPEC CODE This space at the bottom of the form is to be used only when specifically instructed by LDR. Otherwise, leave blank. 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. A corporation or nontaxable entity may file this form to claim its refund of the Louisiana Citizens Property Insurance Corporation assessment(s) that was paid during calendar year 2017. Nontaxable entities include organizations described in either sections 401(a) or 501 of the Internal Revenue Code such as churches, not-for-profit hospitals, charities, community foundations, as well as public entities such as municipalities and school boards. The claim for refund is limited only to the amount of the insurance assessment paid as a result of the additional assessments for Louisiana Citizens Property Insurance Corporation. The amount that is claimed for refund may not include premium taxes paid. 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 6 7 5. All numbers should be rounded to the nearest dollar. 6. Numbers should NOT be entered over the pre-entered zeros, in the boxes on the far right, which are used to designate cents (.00). 7. If the corporation or nontaxable entity is filing an amended return, mark an “X” in the “Amended Return” box. 8. Failure to attach the Insurance Declaration Page may result in the Request for Refund form being returned to you. Name, address, and Revenue Account Number – Enter the corporation’s or nontaxable entity’s legal name, address, and Revenue Account Number in the space provided. If the corporation or nontaxable entity does not have a Louisiana Revenue Account Number, mark the box below the account number field. 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 the 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. The 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. Enter the amount of the paid assessment in the appropriate boxes. • Does the corporation or nontaxable entity own more than one property that incurred an assessment? If the corporation or nontaxable entity had more than one property during 2017 that incurred an assessment, prepare and attach Form R-INS Supplement. For more than four properties, use additional R-INS Supplement forms. Please 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 to: Louisiana Department of Revenue P. O. Box 3576 Baton Rouge, LA 70821-3576
Extracted from PDF file 2016-louisiana-form-r-620ins.pdf, last modified January 2009

More about the Louisiana Form R-620INS Other TY 2016

We last updated the Request for Refund of LA. Citizens Property Insurance in February 2017, so this is the latest version of Form R-620INS, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form R-620INS directly from TaxFormFinder. You can print other Louisiana tax forms here.

Other Louisiana Other 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 R-6140 Credit Utilization Form
Form R-620INS Request for Refund of LA. Citizens Property Insurance
Form R-6170 Transferable Credit Payment Voucher
Form 540CU R Resident Consumer Use Tax
Form 540CU-NR Nonresident Consumer Use Tax

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-620INS from the Department of Revenue in February 2017.

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Historical Past-Year Versions of Louisiana Form R-620INS

We have a total of six past-year versions of Form R-620INS 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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