R-541ES (1/17) 

                         Fiduciary Income Tax                                  Louisiana Department of Revenue
                                                                               P. O. Box 3550
                         Declaration of Estimated Tax (2017)                   Baton Rouge, LA 70821-3550

IMPORTANT NOTICE
The term “estimated tax” means the amount the taxpayer estimates to be the Louisiana income tax imposed for the current 
period. For an estate or trust, payments can be made at anytime prior to filing the return. Estates or trusts making estimated 
declaration of fiduciary income tax for 2017 must complete the payment voucher at the bottom of this page, detach the 
voucher, and mail it to the Louisiana Department of Revenue, P. O. Box 3550, Baton Rouge, LA 70821-3550. The top 
portion of this form should also be completed and retained by the estate or trust as a record of payment.

  • DO NOT SEND CASH.
  •  Complete and retain this portion as a record of payment.

LDR Account Number       FEIN                                Tax Period

Name of Estate or Trust                                      Name and Title of Fiduciary

Address

City                                                         State             ZIP

Amount of payment        Check Number                                          Date Sent
$                       .

                         Detach and submit the voucher below with your payment.

R-541ES (1/17)                                                                                           17 FI
                              Fiduciary Income Tax
LDR Account Number       FEIN                                Tax Period

Name of Estate or Trust                                      Name and Title of Fiduciary

Address

City                                                         State             ZIP

SPEC                     Make payment to:                    Amount 
CODE                     Louisiana Department of Revenue     enclosed u        $
                         P. O. Box 3550                                                                  .
                         Baton Rouge, LA 70821-3550          DO NOT SEND CASH.
                         Please include your LDR Account     Mail date
                         Number on your payment.                                                         1905

                                                             For office use only
       19059             691  12312017