Louisiana Installment Request for Individual Income Bank Debit Application

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Installment Request for Individual Income Bank Debit Application
Form R-90002R-90002 (5/21)

ˇ

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)

I

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 2023-louisiana-form-r-90002.pdf, last modified June 2021

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More about the Louisiana Form R-90002 Individual Income Tax TY 2023

Form R-90002 is an application used to request installments for an individual’s income bank’s debit

We last updated the Installment Request for Individual Income Bank Debit Application in February 2024, so this is the latest version of Form R-90002, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form R-90002 directly from TaxFormFinder. You can print other Louisiana tax forms here.

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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 Tax Return
Form 540-ES	Louisiana Estimated Tax Declaration Voucher For Individuals Estimated
Form R-540INS (Obsolete)	Refund Request of LA Citizens for Property Insurance-Individual
Form 540V	Electronic Filing Payment Voucher Voucher
R-1300	Employee Withholding Exemption Certificate (L-4)

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-90002 from the Department of Revenue in February 2024.

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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-90002

We have a total of two past-year versions of Form R-90002 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2023 Form R-90002

2022 Form R-90002

TaxFormFinder Disclaimer:

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.