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Louisiana Louisiana Youth Jobs Tax Credit Employer Application
Extracted from PDF file 2023-louisiana-form-r-90004.pdf, last modified February 2022Louisiana Youth Jobs Tax Credit Employer Application
R-90004 (1/24) Louisiana Youth Jobs Tax Credit Employer Application Email completed applications to: [email protected] during application period of January 1 to February 28. Louisiana Revised Statute 47:6028 PLEASE PRINT OR TYPE Applicant Information (To be completed by the employer) LA Revenue Account Number or SSN Federal Employer Identification Number Calendar Year of Application Date of Application (mm/dd/yyyy) Legal Name Trade Name Address City Contact Person Name State Email Address ZIP Phone Number Complete the information below for each qualifying youth hired who completed three consecutive months of employment in the calendar year of application listed in the space provided above. You must also have each qualifying employee complete Form R-90004-B, Louisiana Youth Jobs Tax Credit Employee Certification, and attach a copy to this application. If additional lines are needed, use Page 2. Check* if Employed: Last 4 digits of SSN Employee Name Full-Time Part -Time (32 hours per week) (20 hours per week) ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ TO BE COMPLETED BY LDR Credit Amount Approved: *By checking a box, you attest that the employee is working in a full-time or part-time position that pays wages that are equivalent to the wages paid for similar jobs, with adjustments for experience and training. Louisiana Revised Statute 47:1517.1(B)(4) requires the Louisiana Department of Revenue to report on tax incentives that include a job creation component. All taxpayers claiming the Youth Jobs credit are required to attach a completed Form R-6311, Tax Incentives with Job Creation Components, to their income tax return. Form R-6311 does not replace documentation required to be submitted for each credit. Signature and Verification I attest and affirm that the information submitted herein is true and accurate to the best of my knowledge and acknowledge that a finding of misrepresentation of the information presented herein will subject myself and/or my employee to legal and tax consequences, including but not limited to recapture of any credits granted on the basis of such misrepresentation. I further represent that I have exercised due diligence to ensure that all information submitted herein is in compliance with the requirements of R.S. 47:6028 and LAC 61:I.1921 and agree to maintain substantiating documentation to be produced upon the request of the Department of Revenue. Signature Print Name Date (mm/dd/yyyy) Title Telephone Number FOR OFFICIAL USE ONLY Total credit amount approved: Date Application Received (mm/dd/yyyy) Signature and Title of Department Representative Date (mm/dd/yyyy) 1 R-90004 (1/24) Louisiana Youth Jobs Tax Credit Employer Application Email completed applications to: [email protected] during application period of January 1 to February 28. Louisiana Revised Statute 47:6028 PLEASE PRINT OR TYPE Check* if Employed: Employee Name Last 4 digits of SSN Full-Time Part -Time (32 hours per week) (20 hours per week) ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ TO BE COMPLETED BY LDR Credit Amount Approved: *By checking a box, you attest that the employee is working in a full-time or part-time position that pays wages that are equivalent to the wages paid for similar jobs, with adjustments for experience and training. 2
Form R-90004
More about the Louisiana Form R-90004 Individual Income Tax TY 2023
Employees who are eligible and are young between the ages of 16 to 23 may use Form R-90004 to claim Louisiana Youth Jobs Tax Credits
We last updated the Louisiana Youth Jobs Tax Credit Employer Application in February 2024, so this is the latest version of Form R-90004, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form R-90004 directly from TaxFormFinder. You can print other Louisiana tax forms here.
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Form Sources:
Louisiana usually releases forms for the current tax year between January and April. We last updated Louisiana Form R-90004 from the Department of Revenue in February 2024.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
Historical Past-Year Versions of Louisiana Form R-90004
We have a total of two past-year versions of Form R-90004 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
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