Fillable 1. Taxpayer information (please print or type) 2. Appointee ... - revenue louisiana

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R-1100 (10/05) Tax Information Authorization Mail to: Louisiana Department of Revenue Taxpayer Service Division P O Box 66362 Baton Rouge, LA 70896-6362 (225) 219-7656 (225) 219-2114 (TDD) 1. Taxpayer information (please print or type) Taxpayer name(s) (if joint income tax return, enter both names) Mailing address City or Post Office State ZIP Taxpayer SSN or EIN Spouse's SSN (if applicable) State of...
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Fillable 1. Taxpayer information (please print or type) 2. Appointee ... - revenue louisiana

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