Contact Us : Louisiana Department of Revenue

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Basic Infomation Basic Information

*Primary Account Name:

*Primary last 4 digits of Social Security Number: XXX-XX-

Secondary (spouse/joint) Account name:

Secondary last 4 digits of Social Security Number: XXX-XX-

Old Address Information Previous Address

* Address 1:

Address 2:

*City:

*State:

*Zip Code:

New Address Information Current Address

* Address 1:

Address 2:

*City:

*State:

*Zip Code:

*For validation purposes, please tell us the amount of
your Federal Adjusted Gross Income (Line 7) from your prior year's return

*Email Address:

Home Phone Number: Please enter a valid phone number (###) ###-####

Cell Phone Number: Please enter a valid phone number (###) ###-####

Please verify the data entered before you click the "Verified/submit" button