Form R 540Ins Louisiana PDF Details

The R-540INS form serves as a critical tool for Louisiana residents seeking a refund for assessments paid to the Louisiana Citizens Property Insurance Corporation. This particular form, updated in January 2019, is designed to streamline the process for homeowners to claim a refund equal to 25% of the assessment fees they have incurred as part of their property insurance premiums between January 1, 2019, and December 31, 2019. Specifically tailored for those assessed by the Louisiana Citizens Property Insurance Corporation, this document allows individuals either to file for this refund separately or through their individual income tax returns, albeit not on both to avoid processing delays. It requires detailed information including personal identification, property details for which the assessment was paid, and the exact amount of the assessment for either a single property or multiple properties, with a supplemental schedule available for those who need it. The form mandates the inclusion of insurance declaration pages as part of the submission to validate the claim. Moreover, the instructions emphasize the importance of completing the form in black ink for electronic scanning, rounding numbers to the nearest dollar, and avoiding writing over pre-printed zeros to facilitate accurate and efficient processing. The completion and submission of this form represent a direct avenue for Louisiana homeowners to recoup a portion of their property insurance costs, underscoring the state's commitment to providing financial relief to its residents.

QuestionAnswer
Form NameForm R 540Ins Louisiana
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names2019 r540ins printable, r 540 lousiana, r r540ins, refund citizens property

Form Preview Example

R-540INS (1/19)

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Current home address (number and street including apartment number or rural route)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, town, or APO

 

 

State

ZIP

Individual

Income Tax

FILING PERIOD

2019

Your Social

Security Number

Spouse’s Social

Security Number

Area code and daytime telephone number

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. . . . . . . . . . . . . . . . . . 對 . . . .

2. REFUND - Multiply Line 1 by 25 percent (.25). . . . . . . . . . . . . . . . . . 對 . . . .

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)

Spouse’s Signature (If filing jointly, both must sign)

Date (mm/dd/yyyy)

PAID

PREPARER USE ONLY

Print Preparer’s Name

Preparer’s Signature

Date (mm/dd/yyyy)

 

 

 

 

 

Check if Self-employed

 

 

 

 

 

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

 

PTIN, FEIN, or LDR Account Number

Use Only.

 

 

 

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.

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louisiana forms r 540ins for 2020 blanks to fill in

Provide the demanded particulars in the REFUND, Enter the amount of the total, REFUND Multiply Line by, Under penalties of perjury I, Your Signature, Date mmddyyyy, Spouses Signature If filing, Date mmddyyyy, Print Preparers Name, Preparers Signature, Date mmddyyyy, Check if Selfemployed, PAID PREPARER USE ONLY, Firms Name, and Firms Address box.

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