R-6922 (1/13)
                                        Extension       If your name has      If amended return,       If final return, 
                                      O attached      O changed, mark circle. O mark circle.         O mark circle.

                                                                                                     You must enter your Louisiana Revenue 
  Louisiana Composite                                                                                       Account Number here
  Partnership Return
Louisiana Department of Revenue 
P. O. Box 201
                                                                                                            PLEASE PRINT OR TYPE.
Baton Rouge, LA 70821-0201                    Partnership Name

FOR OFFICE USE ONLY.       Field flag         Address

                                              City                                                          State           ZIP
Income Taxable Period

Calender/Fiscal year ending

                                              Summary of tax paid on behalf of partners
  Total distributive income for RESIDENT partners included with the Louisiana Composite Partnership
1                                                                                                                              .00
  Return (Total from Line A of  Resident Partners Schedule)
  Total amount of income tax paid on behalf of qualified Resident partners with this Composite
2                                                                                                                              .00
  Partnership filing. (Total from Line C of Resident Partners Schedule)
  Total distributive income for NONRESIDENT partners included with the Louisiana Composite 
3                                                                                                                              .00
  Partnership Return (Total from Line A of Nonresident Partners Schedule)
  Total amount of income tax paid on behalf of qualified NONRESIDENT partners with this Composite 
4                                                                                                                              .00
  Partnership filing. (Total from Line C of Nonresident Partners Schedule)
                                                      Computation of amount due
5 Total tax (Add Lines 2 and 4 and print the result.)                                                                          .00
  Amount paid on your behalf by a composite partnership filing
6                                     ____________________________________________________________________                     .00
  Print the name of the partnership. 
7 Estimated payments for 2012.                                                                                                 .00
8 Amount paid with extension request                                                                                           .00
9 Total payments (Add Lines 6, 7, and 8 and print the result.)                                                                 .00
10 Overpayment - If Line 9 is greater than Line 5, subtract Line 5 from Line 9 and print the result.                           .00
11 Amount You Owe - If Line 5 is greater than Line 9, subtract Line 9 from Line 5 and print the result.                        .00
12 Interest                                                                                                                    .00
13 Delinquent Filing Penalty                                                                                                   .00
14 Balance Due Louisiana - Add Lines 11, 12, and 13 above and print the result.)                                               .00
Make payment to Louisiana Department of Revenue.                                                                   Do not send cash.

Under penalties of perjury, I declare that I have examined this return including all accompanying documents, and to the best of my  
knowledge and belief, it is true, correct, and complete. Declaration of paid preparer is based on all available information.
Signature                                                                                            Date   (dd/mm/yyyy)

Signature of paid preparer other than taxpayer

Social Security Number, PTIN, or FEIN of paid preparer

                                                        SPEC                                                                2750
                                                        CODE

R-6922 (1/13)
                                                                                         Page                                                                                         of

   Louisiana Composite                            Resident Partners 
   Partnership Return
Louisiana Department of Revenue                                             Schedule
P. O. Box 201
Baton Rouge, LA 70821-0201

                                                                                         PLEASE PRINT OR TYPE.
Partnership Name

Revenue Account Number

   1                            2                                           3       4    5                                                                                            6

                                                  Partner ID                  Included in
                                                  number
                                                                              Composite
                                                  (Social Security 
  Partner                                         Number or Revenue           Return     Distributable                                                                                Distributable
Number                Name and address of partner Account Number)             (Yes/No)   Losses                                                                                       Income

A. Total distributive income for resident partners included with the Louisiana Composite Return ...................................   ___________
   (DO NOT NET DISTRIBUTABLE LOSSES)

B. Tax Rate ........................................................................................................................................................................    X .06

C. Total amount of income tax paid on behalf of qualified resident partners (Multiply the partner’s share of Line A by Line B.) ..........   ___________

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R-6922 (1/13)
                                                                                          Page                                                                                        of

   Louisiana Composite                              Nonresident Partners 
   Partnership Return
Louisiana Department of Revenue                               Schedule
P. O. Box 201
Baton Rouge, LA 70821-0201

                                                                                          PLEASE PRINT OR TYPE.
Partnership Name

Revenue Account Number

   1                      2                 3                 4                5          6                                                                                           7
                                                              Nonresident 
                                            Partner ID        Partner          Included in
                                            number
                                                              Agreement        Composite
                                            (Social Security 
  Partner                                   Number or Revenue Filed            Return     Distributable                           Distributable
Number          Name and address of partner Account Number)   (Yes/No)         (Yes/No)   Losses                                                                                      Income

A. Total distributive income for nonresident partners included with the Louisiana Composite Return .............................   ___________
   (DO NOT NET DISTRIBUTABLE LOSSES)

B. Tax Rate ........................................................................................................................................................................    X .06

C. Total amount of income tax paid on behalf of qualified nonresident partners (Multiply the partner’s share of Line A by Line B.) ....   ___________

                                                                                                                                                                                      2752