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Ldr Form R 540Ins is an Indiana state form that can be used to claim a refund of the excess premiums paid on certain life insurance contracts. The form must be filed within four years of the date the contract was surrendered or terminated. In order to qualify for a refund, the contract must have been in effect for at least two years. If you have paid premium taxes in excess of what was actually needed to pay benefits under a life insurance contract, you may be able to get a refund by filing Ldr Form R 540Ins. The form must be filed within four years of the date the contract was surrendered or terminated. To qualify for a refund, the contract must have been in effect for at least two years.

Here is some information that may help you identify just how long it will take to finish the ldr form r 540ins.

QuestionAnswer
Form NameLdr Form R 540Ins
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesLouisiana, preparer, disbursement, Suffix

Form Preview Example

R-540INS (1/12)

 

 

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

2012

Your Social

Security Number

Spouse’s Social

Security Number

For amended return, mark this box.

Louisiana Revised Statute 47:6025 allows a refundable tax credit to reimburse citizens who paid between January 1, 2012, and December 31, 2012, an assessment to fund the Louisiana Citizens Property Insurance Program as a part of their 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. Print the amount of your paid assessment below on Line 1, Total Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment.

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. Print the total amount of the assessments paid for all properties listed on the Supplement Schedules on Line 1, the Total Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment.

You must attach a copy of your insurance declaration page for all properties.

REFUND

,

1. Total Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment. . . . . . . . . .

.

00

I declare that I have examined this return, and to the best of my knowledge, it is true and complete. Declaration of paid preparer is based on all available information. 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. I understand that by submitting this form I authorize the disbursement of individual income tax refunds through use of an Electronic Access Card (prepaid card).

Your signature

Date

Signature of paid preparer other than taxpayer

 

 

 

 

 

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

Date

Telephone number of paid preparer

Date

 

 

(

)

 

 

 

 

 

 

SPEC CODE

NOTE: All refunds will be issued on an Electronic Access Card (prepaid card).

 

 

Area code and daytime

 

 

MAIL TO:

 

 

telephone number

 

 

 

 

 

 

Louisiana Department of Revenue

 

 

 

 

 

 

 

 

 

 

 

 

P. O. Box 3576

 

 

 

 

 

 

 

 

 

 

 

 

Baton Rouge, LA 70821-3576

6790

R-540INS (1/12)

Instructions for Preparing Your 2012

Louisiana Request for Refund of Louisiana

Citizens Property Insurance Corporation

Assessment (R-540INS)

SPEC

CODE

About this Form

This space at the bottom of the form is to be used only when speciically instructed by LDR. Otherwise, leave blank.

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 ile this form to claim the refund of the Louisiana Citizens Property Insurance Corporation assessment(s) that was paid during calendar year 2012.

2.Print 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 print your numbers inside the boxes like this:

5.All numbers should be rounded to the nearest dollar.

1 2

,

3 4 5

.

00

6.Numbers should NOT be printed over the pre-printed zeros, in the boxes on the far right, which are used to designate cents (.00).

7.If you are iling 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) – Print your name(s), address, and Social Security Number(s) in the space pro- vided. If married, please print 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 allowable credit 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.

Print 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 2012 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 print the total on Line 1, Total Request for Refund of Louisiana Citizens Property Insurance Corporation Assessment.

9. Sign and date the return. Mail to:

Louisiana Department of Revenue

 

P. O. Box 3576

 

Baton Rouge, LA 70821-3576.

6791