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THIS FORM MUST BE FILLED IN. HAND-WRITTEN FORMS WILL NOT BE ACCEPTED!!!!!!!!!!! State of Louisiana Department of Health & Hospitals Louisiana Physical Therapy Board 104 Fair lane Drive, Lafayette,
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What is this form must be?
This form is a tax form.
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Individuals or businesses who meet certain criteria.
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The form must be completed with accurate information.
What is the purpose of this form must be?
The purpose of this form is to report income and taxes.
What information must be reported on this form must be?
Income, expenses, and deductions must be reported on this form.
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