Ldr Form R 540Ins PDF Details

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?Yes
Fillable fields31
Avg. time to fill out6 min 46 sec
Other namesto fill ldr form online, preparer, ldr form, Louisiana

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. . . . . . . . . . . . . . . . . . . . . .

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

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.

How to Edit Ldr Form R 540Ins Online for Free

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propertys empty spaces to fill out

Type in the appropriate information in the area REFUND, Multiply, Line, by, percent Your, Signature Date, mm, dd, yyyy Date, mm, dd, yyyy Print, Preparer, s, Name Preparer, s, Signature Date, mm, dd, yyyy Check, if, Self, employed PAID, PREPARER, USE, ONLY Firms, Name Firms, Address Firms, FEIN Telephone, and MAILTO.

Finishing propertys part 2

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