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R-19023 (03/05)

                           Request for Louisiana Tax Assessment & Lien Payoff

                           P.O. Box 66658
                           Baton Rouge, LA 70896
                           Telephone: (225) 219-7448
                           Fax: (225) 219-2256




Louisiana Revised Statutes 47:1578 provides for the cancellation of a lien when the tax, penalties and interest have been
paid. To secure the amount of payoff on a lien, please complete the form below or attach a copy of the lien(s). Response
time will normally be from 4 to 5 business days. Be sure to include the date to which you want the interest computed.

You may either mail or fax this request to the address or fax number listed above. The response will be mailed to the return
address or faxed to the number you provide.

This request will not stop any applicable interest and/or penalties from accruing or cease any collection action that
is currently being taken.




         Date of Request                                           Payoff/Interest Date

         Tax Account Number                                        Lien Serial Number

         Business Name

         Taxpayer Name

         Parish

         Recordation Information



         Reason for Request




I certify that the above-listed information is correct and the information provided will be used in payment of the lien and will
not be used for any other purpose.



Name                                               Title (If applicable)                      Date

Company

Address

City                                               State                                      ZIP

Telephone Number                                   Fax Number

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Request for Louisiana Tax Assessment and Lien Payoff

  • 1. R-19023 (03/05) Request for Louisiana Tax Assessment & Lien Payoff P.O. Box 66658 Baton Rouge, LA 70896 Telephone: (225) 219-7448 Fax: (225) 219-2256 Louisiana Revised Statutes 47:1578 provides for the cancellation of a lien when the tax, penalties and interest have been paid. To secure the amount of payoff on a lien, please complete the form below or attach a copy of the lien(s). Response time will normally be from 4 to 5 business days. Be sure to include the date to which you want the interest computed. You may either mail or fax this request to the address or fax number listed above. The response will be mailed to the return address or faxed to the number you provide. This request will not stop any applicable interest and/or penalties from accruing or cease any collection action that is currently being taken. Date of Request Payoff/Interest Date Tax Account Number Lien Serial Number Business Name Taxpayer Name Parish Recordation Information Reason for Request I certify that the above-listed information is correct and the information provided will be used in payment of the lien and will not be used for any other purpose. Name Title (If applicable) Date Company Address City State ZIP Telephone Number Fax Number