Form R-6145 "Transferee's Tax Credit Information Disclosure Authorization" - Louisiana

Form R-6145 or the "Transferee's Tax Credit Information Disclosure Authorization" is a form issued by the Louisiana Department of Revenue.

The form was last revised in April 1, 2014 and is available for digital filing. Download an up-to-date Form R-6145 in PDF-format down below or look it up on the Louisiana Department of Revenue Forms website.

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Download Form R-6145 "Transferee's Tax Credit Information Disclosure Authorization" - Louisiana

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R-6145 (4/14)
Transferee’s Tax Credit
Information Disclosure
Authorization
This form only authorizes a one-time release of the form R-6135 to an appointee and must be attached to the Credit Utili-
zation Form, R-6140, authorizing the transfer. A separate R-6145 must be completed by each transferee for each transfer.
This form cannot be used for any other information release.
PLEASE PRINT OR TYPE.
Taxpayer Information — Taxpayer must sign and date this form.
Name
Social Security Number
Address
LA Revenue Account Number
Federal Employer ID Number
City
State
ZIP
Daytime Telephone Number
Appointee
Name
Telephone Number
Address
Fax Number
City
State
ZIP
E-mail Address
Tax Matters
The appointee is authorized to receive the Form R-6135, Credit Registration Form, from the Louisiana Department of
Revenue for the transferable tax credit listed below:
Transfer Date
LDR State Certification Number
(mm/dd/yyyy)
Signature of Taxpayer
I certify that I have the authority to execute this form with respect to the tax matters above.
Signature
Print Name
X
Title
Date
(mm/dd/yyyy)
If not signed and dated, the form R-6135 will be mailed to the Taxpayer.
Signature of Taxpayer
Form R-6145 must be signed and dated by the taxpayer listed in the Taxpayer Information section.
Individuals — The Taxpayer must sign and date the authorization.
Corporations — Generally, Form R-6145 can be signed by: (1) an officer having legal authority to bind the corporation, (2) any person designated by
the board of directors or other governing body, or (3) any officer or employee on written request by any principal officer and attested to by the secretary
or other officer.
Partnerships — Generally, Form R-6145 can be signed by any person who is a member of the partnership.
All others — Generally, Form R-6145 can be signed by any person who has authority to execute any form with respect to tax matters.
R-6145 (4/14)
Transferee’s Tax Credit
Information Disclosure
Authorization
This form only authorizes a one-time release of the form R-6135 to an appointee and must be attached to the Credit Utili-
zation Form, R-6140, authorizing the transfer. A separate R-6145 must be completed by each transferee for each transfer.
This form cannot be used for any other information release.
PLEASE PRINT OR TYPE.
Taxpayer Information — Taxpayer must sign and date this form.
Name
Social Security Number
Address
LA Revenue Account Number
Federal Employer ID Number
City
State
ZIP
Daytime Telephone Number
Appointee
Name
Telephone Number
Address
Fax Number
City
State
ZIP
E-mail Address
Tax Matters
The appointee is authorized to receive the Form R-6135, Credit Registration Form, from the Louisiana Department of
Revenue for the transferable tax credit listed below:
Transfer Date
LDR State Certification Number
(mm/dd/yyyy)
Signature of Taxpayer
I certify that I have the authority to execute this form with respect to the tax matters above.
Signature
Print Name
X
Title
Date
(mm/dd/yyyy)
If not signed and dated, the form R-6135 will be mailed to the Taxpayer.
Signature of Taxpayer
Form R-6145 must be signed and dated by the taxpayer listed in the Taxpayer Information section.
Individuals — The Taxpayer must sign and date the authorization.
Corporations — Generally, Form R-6145 can be signed by: (1) an officer having legal authority to bind the corporation, (2) any person designated by
the board of directors or other governing body, or (3) any officer or employee on written request by any principal officer and attested to by the secretary
or other officer.
Partnerships — Generally, Form R-6145 can be signed by any person who is a member of the partnership.
All others — Generally, Form R-6145 can be signed by any person who has authority to execute any form with respect to tax matters.
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