Form 41 Ls PDF Details

Are you familiar with Form 41 LS? This is a Louisiana state tax form that is used to report certain types of income derived from sources within the state. The form must be filed by all individuals and businesses that have income taxable in Louisiana. If you're not sure whether or not your income is taxable in LA, or if you need help completing the form, be sure to contact an accountant or tax professional. Filing this form is important, as it helps ensure that you are paying the correct amount of taxes on your income. With just a few simple steps, you can easily complete Form 41 LS and submit it to the Louisiana Department of Revenue.

Here is the information regarding the form you were looking for to fill in. It can show you the span of time you will need to finish form 41 ls, exactly what fields you will have to fill in and several additional specific facts.

QuestionAnswer
Form NameForm 41 Ls
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names41-LS, form 41 ls, BIL, 41 ls form

Form Preview Example

REQUEST FOR LIVE SCAN SERVICE

FORM 41-LS Rev. 07/11

Applicant Submission

ORI:

 

 

 

 

 

 

 

 

 

 

 

 

Type of Application:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code assigned by DOJ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Title or Type of License, Certification or Permit:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Address Set Contributing Agency:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency authorized to receive criminal history information

 

 

 

 

Mail Code (five-digit code assigned by DOJ)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

Street or PO Box

 

 

 

 

 

 

 

 

 

 

 

 

Contact Name (Mandatory for all school submissions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

Zip Code

 

 

 

 

Contact Telephone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Applicant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please print)

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

MI

 

 

Alias:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License No:

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

Sex:

 

 

 

 

Male

 

 

Female

Misc. No. BIL -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Billing Number

 

Height:

 

 

 

 

Weight:

 

 

 

 

 

 

 

 

 

 

 

 

 

Misc. Number:

 

 

 

 

 

 

 

 

 

Eye Color:

 

 

 

Hair Color:

 

 

 

 

 

 

 

 

 

 

 

 

Home Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

 

 

Street or PO Box

 

Place of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State and Zip Code

 

 

Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OCA No. (Applicant Social Security No.)

 

 

 

 

Level of Service:

 

 

DOJ

 

FBI

 

If resubmission, list Original ATI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer: (Additional response for agencies specified by statute)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

 

Street or PO Box

 

 

 

 

 

 

 

 

 

 

Mail Code (five digit code assigned by DOJ)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

 

 

Agency Telephone No. (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Live Scan Transaction Completed By:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Operator

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmitting Agency

 

 

 

 

 

 

 

 

 

ATI No.

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount Collected/Billed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORIGINAL – Live Scan Operator; SECOND COPY – Applicant; THIRD COPY (if needed) – Requesting Agency

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Write down the data in Date of Birth, Sex, Male, Female Misc No BIL, Height, Weight, Eye Color, Hair Color, Place of Birth, Social Security Number, Your Number, Agency Billing Number, Misc Number, Home Address, and Street No.

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