LOUISIANA FILE ONLINE Fast. Easy. Absolutely Free. revenue.louisiana.gov/fileonline Are you due a refund? If you file this paper return, it will take up to 14 weeks to get your refund check. With Louisiana File Online and direct deposit, you can receive your refund within 45 days.

Your legal first name Init. Last name Suffix If joint return, spouse’s name Init. Last name Suffix Present home address (number and street including rural route) Unit Type Number City, Town, or APO State ZIP Foreign Nation, if not United States (do not abbreviate) IMPORTANT! Your SSN Spouse’s SSN Area code and daytime telephone number M M D D Y Y Y Y M M D D Y Y Y Y 2022 LOUISIANA RESIDENT IT-540-WEB (Page 1 of 4) 62330 You must enter your SSN below in the same order as shown on your federal return. FILING STATUS: Enter the appropriate number in the filing status box. It must agree with your federal return. Enter a “1” in box if single. Enter a “2” in box if married filing jointly. Enter a “3” in box if married filing separately. Enter a “4” in box if head of household. If the qualifying person is not your dependent, enter name here. Enter a “5” in box if qualifying widow(er). If the qualifying person is not your dependent, enter name here. 6 EXEMPTIONS: 6A Yourself 65 or older Blind Qualifying Widow(er) 6B Spouse 65 or older Blind Total of 6A & 6B 6C DEPENDENTS – Enter dependent information below. If you have more than 6 dependents, attach a statement to your return with the

required information. Enter the number of dependents claimed on Federal Form 1040 or 1040-SR in the boxes here. 6C First Name Last Name Social Security Number Relationship to you Birth Date (mm/dd/yyyy) X Your Date of Birth Spouse’s Date of Birth IMPORTANT! All four (4) pages of this return MUST be mailed in together along with your W-2s and completed schedules. Please paperclip. Do not staple. FOR OFFICE USE ONLY Field Flag Decedent Filing Name Change Address Change Amended Return NOL Carryback Spouse Decedent Mark Box: 6D EXEMPTIONS – Total of 6A, 6B, and 6C 6D 6E DEPENDENTS FOR CERTAIN ADOPTIONS DEDUCTION – Enter the number of dependents included on Line 6C for whom you are claiming the Deduction for Certain Adoptions. Enter name here. _________________________________ 6E 6F TOTAL EXEMPTIONS – Subtract Line 6E from Line 6D. 6F WEB

Enter the first 4 letters of your last name in these boxes. CONTINUE ON NEXT PAGE. Enter your Social Security Number. 62331 If you are not required to file a federal return, indicate wages here. 7 FEDERAL ADJUSTED GROSS INCOME – If your Federal Adjusted Gross Income is less than zero, enter “0.” From Louisiana Schedule E, attached If you did not itemize your deductions on your federal return, leave Lines 8A through 8D blank and go to Line 9. 8A FEDERAL ITEMIZED DEDUCTIONS 8B FEDERAL ITEMIZED DEDUCTION FOR MEDICAL AND DENTAL EXPENSES 8C FEDERAL STANDARD DEDUCTION 8D EXCESS FEDERAL ITEMIZED DEDUCTIONS – Subtract Line 8C from Line 8B. 9 YOUR LOUISIANA TAX TABLE INCOME – Subtract Line 8D from Line 7. If less than zero, enter “0.” Use this figure to find your tax in the tax tables. 10 YOUR LOUISIANA INCOME TAX – Enter the amount from the tax table that corresponds with your filing status. 11 NONREFUNDABLE PRIORITY 1 CREDITS – From Schedule C, Line 6 12 TAX LIABILITY AFTER NONREFUNDABLE PRIORITY 1 CREDITS – Subtract Line 11 from Line 10. If the result is less than zero, or you are not required to file a federal return, enter zero “0.” Mark this box and enter zero “0” on Line 12. 7 8A 8B 8C 8D 9 10 11 12 13 13A 13B 14 15 16 17 18 19 20 2022 Form IT-540-WEB (Page 2 of 4) 13 2022 LOUISIANA REFUNDABLE CHILD CARE CREDIT – Your Federal Adjusted Gross Income must be EQUAL TO OR LESS THAN $25,000 to claim the credit on this line. See the instructions and the Refundable Child Care Credit Worksheet. 13A Enter the qualified expense amount from the Refundable Child Care Credit Worksheet, Line 3. 13B Enter the amount from the Refundable Child Care Credit Worksheet, Line 6. 14 2022 LOUISIANA REFUNDABLE SCHOOL READINESS CREDIT – Your Federal Adjusted Gross Income must be EQUAL TO OR LESS THAN $25,000 to claim the credit on this line. See the Refundable School Readiness Credit Worksheet. 15 EARNED INCOME CREDIT – See Louisiana Earned Income Credit (LA EIC) Worksheet, Line 3. 16 OTHER REFUNDABLE PRIORITY 2 CREDITS – From Schedule F, Line 9 17 TOTAL REFUNDABLE PRIORITY 2 CREDITS – Add Lines 13, and 14 through 16. Do not include amounts on Lines 13A and 13B. 18 TAX LIABILITY AFTER REFUNDABLE PRIORITY 2 CREDITS 19 OVERPAYMENT AFTER REFUNDABLE PRIORITY 2 CREDITS 20 NONREFUNDABLE PRIORITY 3 CREDITS – From Schedule J, Line 16 5 4 3 2 WEB

COMPLETE AND SIGN RETURN ON NEXT PAGE. Enter the first 4 letters of your last name in these boxes. Enter your Social Security Number. 62332 30 TOTAL REFUNDABLE TAX CREDITS AND PAYMENTS – Add Lines 24 through 29. 31 OVERPAYMENT – If Line 30 is greater than Line 23, subtract Line 23 from Line 30. Your overpayment may be reduced by the Underpayment of Estimated Tax Penalty. Otherwise, go to Line 38. 32 UNDERPAYMENT PENALTY – See the instructions for Underpayment Penalty and Form R-210R. If you are a farmer, check the box. 33 ADJUSTED OVERPAYMENT – If Line 31 is greater than Line 32, subtract Line 32 from Line 31, and enter on Line 33. If Line 32 is greater than Line 31, subtract Line 31 from Line 32, and enter the balance on Line 38. 34 TOTAL DONATIONS – From Schedule D, Line 22 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 PAYMENTS 26 AMOUNT OF LOUISIANA TAX WITHHELD FOR 2022 – Attach Forms W-2 and 1099. 27 AMOUNT OF CREDIT CARRIED FORWARD FROM 2021 28 AMOUNT OF ESTIMATED PAYMENTS MADE FOR 2022 29 AMOUNT OF EXTENSION PAYMENT 24 OVERPAYMENT OF REFUNDABLE PRIORITY 2 CREDITS – Enter the amount from Line 19. 25 REFUNDABLE PRIORITY 4 CREDITS – From Schedule I, Line 6 Routing Number Type: Checking Savings Account Number Yes No Will this refund be forwarded to a financial institution located outside the United States? REFUND DUE 35 SUBTOTAL – Subtract Line 34 from Line 33. This amount of overpayment is available for credit or refund. 36 AMOUNT OF LINE 35 TO BE CREDITED TO 2023 INCOME TAX CREDIT 37 AMOUNT TO BE REFUNDED – Subtract Line 36 from Line 35. If mailing to LDR, use Address 2 on the next page. Enter a “2” in box if you want to receive your refund by paper check. Enter a “3” in box if you want to receive your refund by direct deposit. Complete information below. If information is unreadable, you are filing for the first time, or if you do not make a refund selection, you will receive your refund by paper check. REFUND DIRECT DEPOSIT INFORMATION 21 ADJUSTED LOUISIANA INCOME TAX – Subtract Line 20 from Line 18. 22 CONSUMER USE TAX - You must mark one of these boxes.

23 TOTAL INCOME TAX AND CONSUMER USE TAX – Add Lines 21 and 22. No use tax due. Amount from the Consumer Use Tax Worksheet. WEB 2022 Form IT-540-WEB (Page 3 of 4)

Individual Income Tax Return Calendar year return due 5/15/2023 Enter the first 4 letters of your last name in these boxes. PTIN, FEIN, or LDR Account Number of Paid Preparer DO NOT SEND CASH. AMOUNTS DUE LOUISIANA 38 AMOUNT YOU OWE – If Line 23 is greater than Line 30, subtract Line 30 from Line 23. 39 ADDITIONAL DONATION TO THE MILITARY FAMILY ASSISTANCE FUND 40 ADDITIONAL DONATION TO THE COASTAL PROTECTION AND RESTORATION FUND 41 ADDITIONAL DONATION TO LOUISIANA FOOD BANK ASSOCIATION 42 INTEREST – From the Interest Calculation Worksheet, Line 5. 43 DELINQUENT FILING PENALTY – From the Delinquent Filing Penalty Calculation Worksheet, Line 3. 44 DELINQUENT PAYMENT PENALTY – From Delinquent Payment Penalty Calculation Worksheet, Line 7. 45 UNDERPAYMENT PENALTY – See the instructions for Underpayment Penalty and Form R-210R. If you are a farmer, check the box. 46 BALANCE DUE LOUISIANA – Add Lines 38 through 45. If mailing to LDR, use address 1 below. For electronic payment options, see instructions. PAY THIS AMOUNT. 62333 Enter your Social Security Number. 38 39 40 41 42 43 44 45 46 IMPORTANT! All four (4) pages of this return MUST be mailed in together along with your W-2s and completed schedules. Please paperclip. Do not staple. 1

Mail Balance Due Return with Payment TO: Department of Revenue

P. O. Box 3550

Baton Rouge, LA 70821-3550 2 Mail All Other Individual Income Tax Returns TO: Department of Revenue

P. O. Box 3440

Baton Rouge, LA 70821-3440 { A d d r e s s } Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. If I made a contribution to a START Savings Program, I consent that my Social Security Number may be given to the Louisiana Office of Student Financial Assistance to properly identify the START Savings Program account holder. If married filing jointly, both Social Security Numbers may be submitted. I understand that by submitting this form I authorize the disbursement of individual income tax refunds through the method as described on Line 37. Your Signature Date (mm/dd/yyyy) Spouse’s Signature (If filing jointly, both must sign.) Date (mm/dd/yyyy) PAID PREPARER USE ONLY Print/Type Preparer’s Name Preparer’s Signature Date (mm/dd/yyyy) Check ■ if Self-employed Firm’s Name ➤ Firm’s FEIN ➤ Firm’s Address ➤ Telephone ➤ For Office Use Only. WEB 2022 Form IT-540-WEB (Page 4 of 4)

File electronically! www.revenue.louisiana.gov/fileonline SCHEDULE C – 2022 NONREFUNDABLE PRIORITY 1 CREDITS Enter your Social Security Number. 62334 1A 1B 1 CREDIT FOR TAX LIABILITIES PAID TO OTHER STATES – A copy of the return filed with the other states and Form R-10606 must be submitted with this schedule. 1A Enter the total of Net Tax Liability Paid to Other States from Form R-10606. 1B Enter the Credit for Taxes Paid to Other States from Form R-10606. Additional Nonrefundable Priority 1 Credits Enter credit description and associated code, along with the dollar amount of credit claimed. See the instructions. 2 3 4 5 6 TOTAL NONREFUNDABLE PRIORITY 1 CREDITS – Add Lines 1B, and 2 through 5. Also, enter this amount on Form IT-540, Line 11.

Credit Description Credit Code Amount of Credit Claimed 2 3 4 5 6 Description Code Premium Tax 100 Bone Marrow 120 Description Code Qualified Playgrounds 150 Debt Issuance 155 Description Code Other 199 ATTACH TO RETURN IF COMPLETED. WEB

DONATIONS OF LINE 1 2 The Military Family Assistance Fund 3 Coastal Protection and Restoration Fund 4 The START Program 5 Wildlife Habitat and Natural Heritage Trust Fund 6 Louisiana Cancer Trust Fund 7 Louisiana Pet Overpopulation Advisory Council 8 Louisiana Food Bank Association 9 Make-A-Wish Foundation of the Texas Gulf Coast and Louisiana 10 Louisiana Association of United Ways/LA 2-1-1 11 American Red Cross DONATIONS OF LINE 1 12 Louisiana National Guard Honor Guard for Military Funerals 13 Louisiana State Troopers Charities, Inc. 14 Louisiana Horse Rescue Association 15 Louisiana Coalition Against Domestic Violence 16 Dreams Come True, Inc. 17 Sexual Trauma Awareness and Response (STAR) 18 Louisiana State University Agricultural Center Grant Walker Educational Center (4-H Camp Grant Walker) 19 Maddie’s Footprints 20 University of New Orleans Foundation 21 Southeastern Louisiana University Foundation SCHEDULE D – 2022 DONATION SCHEDULE Individuals who file an individual income tax return and have overpaid their tax may choose to donate all or part of their overpayment shown on Line 33 of Form IT-540 to the organizations or funds listed below. Enter on Lines 2 through 21, the portion of the overpayment you wish to donate. The total on Line 22 cannot exceed the amount of your overpayment on Line 33 of Form IT-540. Enter your Social Security Number. 62335 1 Adjusted Overpayment – From IT-540, Line 33 12 13 14 15 16 17 18 19 20 21 1 2 3 4 5 6 7 8 9 10 11 22 TOTAL DONATIONS – Add Lines 2 through 21. This amount cannot be more than Line 1. Also, enter this amount on Form IT-540, Line 34. 22 ATTACH TO RETURN IF COMPLETED. WEB

SCHEDULE E – 2022 ADJUSTMENTS TO INCOME 1 FEDERAL ADJUSTED GROSS INCOME – Enter the amount from your Federal Form 1040 or 1040-SR, Line 11. Check box if amount is less than zero. 2A INTEREST AND DIVIDEND INCOME FROM OTHER STATES AND THEIR POLITICAL SUBDIVISIONS 2B RECAPTURE OF START CONTRIBUTIONS 2C RECAPTURE OF START K12 CONTRIBUTIONS 2D ADD BACK OF PASS – THROUGH ENTITY LOSS 3 TOTAL – Add Lines 1, 2A, 2B, 2C, and 2D. EXEMPT INCOME – Enter on Lines 4A through 4G the amount of exempted income included in Line 1 above. Enter the description and associated code, along with the dollar amount. See the instructions. Exempt Income Description Code

Amount 4A 4B 4C 4D 4E 4F 4G 4H EXEMPT INCOME – Add Lines 4A through 4G. 5 LOUISIANA ADJUSTED GROSS INCOME – Subtract Line 4H from Line 3. Also, enter this amount on Form IT-540, Line 7. Mark the box on Form IT-540, Line 7, indicating that Schedule E was used. Description - See instructions. Code Interest and Dividends on U.S. Government Obligations 01E Louisiana State Employees’ Retirement Benefits Taxpayer date retired: Spouse date retired: 02E Louisiana State Teachers’ Retirement Benefits Taxpayer date retired: Spouse date retired: 03E Federal Retirement Benefits Taxpayer date retired: Spouse date retired: 04E Other Retirement Benefits – Provide name or statute: _______________________________________________ Taxpayer date retired: Spouse date retired: 05E Annual Retirement Income Exemption for Taxpayers 65 or over Provide name of pension or annuity: _______________________________________________________________ 06E Enter your Social Security Number. 62336 1 2A 2B 2C 2D 3 4A 4B 4C 4D 4E 4F 4G 4H 5 E E E E E E E M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y Description - See instructions. Code Taxable Amount of Social Security 07E Native American Income 08E START Savings Program Contribution 09E Military Pay Exclusion 10E Road Home 11E Recreation Volunteer 13E Volunteer Firefighter 14E Voluntary Retrofit Residential Structure 16E Elementary and Secondary School Tuition 17E Educational Expenses for Home-Schooled Children 18E Educational Expenses for Quality Public Education 19E Capital Gain from Sale of Louisiana Business 20E Employment of Certain Qualified Disabled Individuals 21E S Bank Shareholder Income Exclusion 22E Entity Level Taxes Paid to Other States 23E Pass - Through Entity Exclusion 24E IRC 280C Expense Adjustment 25E COVID-19 Relief Benefits 27E START K12 Savings Program Contributions 28E Digital Nomads 29E Certain Adoptions 30E Other, see instructions. Identify: ____________________________________________ 49E ATTACH TO RETURN IF COMPLETED. File electronically! www.revenue.louisiana.gov/fileonline WEB

2022 Louisiana School Expense Deduction Worksheet Your Name Your Social Security Number I. This worksheet should be used to calculate the three School Expense Deductions listed below. Refer to Revenue Information Bulletins 09-019 and 12-008 on LDR’s website for more information. Expenses paid with amounts deducted as START K12 Savings Program Contributions are not eligible for this deduction. 1. Elementary and Secondary School Tuition – R.S. 47:297.10 provides a deduction for amounts paid during the tax year for tuition and fees required for your dependent child’s enrollment in a nonpublic elementary or secondary school that complies with the criteria set forth in Brumfield v. Dodd and Section 501(c)(3) of the Internal Revenue Code or to any public elementary or secondary laboratory school that is operated by a public college or university. The school can verify that it complies with the criteria. The deduction is equal to the actual amount of tuition and fees paid per dependent, limited to $5,000. The tuition and fees that can be deducted include amounts paid for tuition, fees, uniforms, textbooks and other supplies required by the school. 2. Educational Expenses for Home-Schooled Children – R.S. 47:297.11 provides a deduction for educational expenses paid during the tax year for home-schooling your dependent child. In order to qualify for the deduction, you must be approved by the State Board of Elementary and Secondary Education (BESE) for home-schooling. The deduction is equal to 50 percent of the actual qualified educational expenses paid for the home-schooling per dependent, limited to $5,000. Qualified educational expenses include amounts paid for the purchase of textbooks and curricula necessary for home-schooling. 3. Educational Expenses for a Quality Public Education – R.S. 47:297.12 provides a deduction for the fees or other amounts paid during the tax year for a quality education of a dependent child enrolled in a public elementary or secondary school, including Louisiana Department of Education approved charter schools. The deduction is equal to 50 percent of the amounts paid per dependent, limited to $5,000. The amounts that can be deducted include amounts paid for uniforms, textbooks and other supplies required by the school. II. On the chart below, list the name of each qualifying dependent and the name of the school the student attends. If the student is home-schooled, enter “home-schooled.” Enter an “X” in the box in column 1 if your dependent qualifies for the Elementary and Secondary School Tuition deduction, column 2 for Educational Expenses for Home-Schooled Children deduction, or column 3 for Quality Public Education deduction. If you have more than six qualifying dependents, attach a statement to your return with the required information. Student Name of Qualifying Dependent Name of School Deduction as described above in Section I 1 2 3 A B C D E F III. Using the letters that correspond to each qualifying dependent listed in Section II, list the amount paid per student for each qualifying expense. For students attending a qualifying school, the expense must be for an item required by the school. Refer to the information in Section I to determine which expenses qualify for the deduction. Retain copies of canceled checks, receipts and other documentation in order to support the amount of qualifying expenses. If you checked column 1 in Section II, skip the 50% calculation below; however, the deduction is still limited to $5,000. Qualifying Expense List the amount paid for each student as listed in Section II. A B C D E F Tuition and Fees School Uniforms Textbooks or Other Instructional Materials Supplies Total (add amounts in each column) If column 2 or 3 in Section II was checked, multiply by: 50% 50% 50% 50% 50% 50% Deduction per Student – Enter the result or $5,000, whichever is less. IV. Total the Deduction per Student in Section III, based on the deduction for which the students qualified as marked in boxes 1, 2, or 3 in Section II. Enter the Elementary and Secondary School Tuition Deduction here and on IT-540, Schedule E, code 17E. $ Enter the Educational Expenses for Home-Schooled Children Deduction here and on IT-540, Schedule E, code 18E. $ Enter the Educational Expenses for a Quality Public Education Deduction here and on IT-540, Schedule E, code 19E. $ 62308 ATTACH TO RETURN IF COMPLETED. WEB

SCHEDULE F – 2022 REFUNDABLE PRIORITY 2 CREDITS Enter credit description and associated code, along with the dollar amount of credit claimed. See the instructions.

Credit Description Credit Code Amount of Credit Claimed 1 2 3 4 5 5A School Readiness Child Care Directors and Staff Credit - Facility License Number Enter your Social Security Number. 62337 1 2 3 4 5 6 7 8 9 Transferable, Refundable Priority 2 Credits Enter the State Certification Number from Form R-6135, along with the dollar amount of credit claimed. See the instructions.

Credit Description Credit Code Amount of Credit Claimed 6. Musical and Theatrical Production 6A.

7. Musical and Theatrical Production 7A. 8. Musical and Theatrical Production 8A. 9. OTHER REFUNDABLE PRIORITY 2 CREDITS – Add Lines 1 through 8. Also, enter this amount on Form IT-540, Line 16. 6 2 F F F F F F 6 2 F 6 2 F Description Code School Readiness Business – Supported Child Care 67F School Readiness Fees and Grants to Resource and Referral Agencies 68F Retention and Modernization 70F Digital Interactive Media & Software 73F Description Code Stillborn Child 76F Funeral and Burial Expense for a Pregnancy-related Death 77F Other Refundable Credit 80F Description Code Technology Commercialization 59F Historic Residential 60F School Readiness Child Care Provider 65F School Readiness Child Care Directors and Staff 66F Description Code Ad Valorem Offshore Vessels 52F Telephone Company Property 54F Prison Industry Enhancement 55F Milk Producers 58F ATTACH TO RETURN IF COMPLETED. WEB

SCHEDULE I – 2022 REFUNDABLE PRIORITY 4 CREDITS Enter credit description and associated code, along with the dollar amount of credit claimed. See the instructions.

Credit Description Credit Code Amount of Credit Claimed 1 2 3 4 5 6 TOTAL REFUNDABLE PRIORITY 4 CREDITS – Add Lines 1 through 5. Also, enter this amount on Form IT-540, Line 25. 1 2 3 4 5 6 Description Code Inventory Tax 50F Ad Valorem Natural Gas 51F Enter your Social Security Number. 62338 F F F F F ATTACH TO RETURN IF COMPLETED. WEB

Nonrefundable Child Care Credits 1 FEDERAL CHILD CARE CREDIT – Enter the amount from your Federal Form 1040 or 1040-SR, Schedule 3, Line 2. This amount will be used to compute your 2022 Louisiana Nonrefundable Child Care Credit. 1 2 2022 LOUISIANA NONREFUNDABLE CHILD CARE CREDIT – Your Federal Adjusted Gross Income must be GREATER THAN $25,000 in order to claim a credit on this line. See the Nonrefundable Child Care Credit Worksheet. 2 3 AMOUNT OF LOUISIANA NONREFUNDABLE CHILD CARE CREDIT CARRIED FORWARD FROM 2017 THROUGH 2021 – See the Nonrefundable Child Care Credit Worksheet. 3 4 2022 LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT – Your Federal Adjusted Gross Income must be GREATER THAN $25,000 in order to claim a credit on this line. See the Nonrefundable School Readiness Credit Worksheet. 4 5 4 3 2 5 AMOUNT OF LOUISIANA NONREFUNDABLE SCHOOL READINESS CREDIT CARRIED FORWARD FROM 2017 THROUGH 2021 – See the Nonrefundable School Readiness Credit Worksheet. 5 Enter your Social Security Number. 62339 SCHEDULE J – 2022 NONREFUNDABLE PRIORITY 3 CREDITS Additional Nonrefundable Priority 3 Credits Enter credit description and associated code, along with the dollar amount of credit claimed. See the instructions.

Credit Description Credit Code Amount of Credit Claimed 6 7 8 9 10 11 6 7 8 9 10 11 CONTINUE ON NEXT PAGE. IMPORTANT! Only these codes can be claimed on Lines 6 through 11. Description Code Organ Donation 202 Previously Unemployed 208 Owner of Accessible and Barrier-free Home 221 New Jobs Credit 224 Eligible Re-entrants 228 Apprenticeship (2007) 236 Biomed/University Research 300 Tax Equalization 305 Description Code Manufacturing Establishments 310 Other 399 Refunds by Utilities 412 Donation to School Tuition Organization 424 QMC Music Job Creation Credit 454 Neighborhood Assistance 457 Research and Development 458 Ports of Louisiana Import Export Cargo 459 Description Code LA Import 460 LA Work Opportunity 461 Youth Jobs 462 Apprenticeship (2022) 463 Donation to Qualified Foster Care Charitable Organization 464 Inventory Tax Credit Carried Forward and ITEP 500 Ad Valorem Natural Gas Credit Carried Forward 502 Atchafalaya Trace 504 Description Code Cane River Heritage 506 Ports of Louisiana Investor 508 Enterprise Zone 510 Recycling Credit 550 Other 599 ATTACH TO RETURN IF COMPLETED. WEB File electronically! www.revenue.louisiana.gov/fileonline

Description Code New Markets 259 Motion Picture Infrastructure 261 Description Code Angel Investor 262 Other 299 Description Code Digital Interactive Media 254 Capital Company 257 LCDFI 258 Description Code Motion Picture Investment 251 Research and Development 252 Historic Structures 253 Enter your Social Security Number. 62340 SCHEDULE J – 2022 NONREFUNDABLE PRIORITY 3 CREDITS ...CONTINUED 12 12A

13 13A 14 14A 15 15A 16 TOTAL NONREFUNDABLE PRIORITY 3 CREDITS – Add Lines 2 through 15. Also, enter this amount on Form IT-540, Line 20. Transferable, Nonrefundable Priority 3 Credits Enter credit description, associated code, along with the dollar amount of credit claimed and the State Certification Number from Form R-6135. See the instructions.

Credit Description Credit Code Amount of Credit Claimed 12 13 14 15 16 IMPORTANT! Only these codes can be claimed on Lines 12 through 15. ATTACH TO RETURN IF COMPLETED. WEB File electronically! www.revenue.louisiana.gov/fileonline

Your Name Social Security Number 3 Add the amounts in column H, Line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. Enter this amount here and on Form IT-540, Line 13A. 3 .00 4 Enter your earned income. See the definitions in the instructions. 4 .00 5 If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was disabled, see IRS Publication 503). All other filing statuses, enter the amount from Line 4. 5 .00 6 Enter the smallest of Lines 3, 4, or 5. Enter this amount on Form IT-540, Line 13B. 6 .00 7 Enter your Federal Adjusted Gross Income from Form IT-540, Line 7, or Schedule E, Line 1, if filed. 7 .00 8 Enter on Line 8 the decimal amount shown below that applies to the amount on Line 7.

If Line 7 is: over but not over decimal amount

$0 $15,000 .35

$15,000 $17,000 .34

$17,000 $19,000 .33

$19,000 $21,000 .32

$21,000 $23,000 .31

$23,000 $25,000 .30 8 X ._________ 9 Multiply Line 6 by the decimal amount on Line 8. 9 .00 10 Multiply Line 9 by 50 percent and enter this amount on Line 11. 10 X .50 11 Enter this amount on Form IT-540, Line 13. 11 .00 2. For each child under age 13, enter their name in column F, their Social Security Number in column G, and the amount of Qualified Expenses you incurred and paid in 2022 in column H. See the definitions in the instructions for information on Qualified Expenses. Your Federal Adjusted Gross Income must be $25,000 or less in order to complete this form. See the Louisiana Child Care Credit instructions. 1. Care Provider Information Schedule – Complete columns A through E for each person or organization that provided care to your child. You may use Federal Form W-10, supplied by your provider, to obtain the information. If your care provider does not provide a Federal Form W-10, complete those parts of the Care Provider Information Schedule for which you have the information. If your child attended a child care facility that participated in the Quality Start program, you must enter the facility license number from Form R-10614 in column D. You must follow the same rules of “Due Diligence” as the IRS requires if you do not have all of the care provider information. See IRS 2022 Publication 503 for information on “Due Diligence.” Retain copies of canceled checks, receipts and other documentation in order to support the amount of qualifying expenses. If additional lines are required for Lines 1 or 2, attach a schedule. Falsification of any information provided on this form constitutes fraud and can result in criminal penalties. A B C D E Care provider’s name Address (number, street, apartment number, city, state, and ZIP) Identifying number (SSN or EIN) Facility license number Amount paid (See instructions.) .00 .00 .00 .00 .00 F G H Qualifying person’s name

First Last Qualifying person’s Social Security Number Qualified expenses you incurred and paid in 2022 for the person listed in column (F) .00 .00 .00 .00 .00 62313 ATTACH THIS WORKSHEET TO YOUR RETURN IF COMPLETED. 2022 Louisiana Refundable Child Care Credit Worksheet (For use with Form IT-540) WEB

R.S. 47:6104 provides a School Readiness Credit in addition to the credit for child care expenses as provided under R.S. 47:297.4. To qualify for this credit, the taxpayer must have Federal Adjusted Gross Income of $25,000 or less and must have incurred child care expenses for a qualified dependent under age six who attended a child care facility that is participating in the Quality Start Rating program administered by the Louisiana Department of Education. The qualifying child care facility must have provided the taxpayer with Form R-10614 which verifies the facility’s name, the facility license number, the LA Revenue Account number, the Quality Star Rating, and the rating award date. A copy of Form R-10614 must be attached to your return. You must enter the facility license number in column D on Line 1 of the 2022 Louisiana Refundable Child Care Credit Worksheet to receive this credit. Retain copies of canceled checks, receipts and other documentation in order to support the amount of qualifying expenses. Complete this worksheet only if you claimed a Louisiana Refundable Child Care Credit on Form IT-540, Line 13. 1. Enter the amount of 2022 Louisiana Refundable Child Care Credit found on the Louisiana Refundable Child Care Credit Worksheet, Line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . 00 Using the Quality Star Rating of the child care facility that your qualified dependent attended during 2022, shown on Form R-10614, determine the applicable percentage for the School Readiness Credit from the chart shown below: (A) Quality Rating (B) Percentages for Star Rating Five Star 200% (2.0) Four Star 150% (1.5) Three Star 100% (1.0) Two Star 50% (.50) One Star 0% (.00) 2. Enter the number of your qualified dependents under age six who attended a:

Five Star Facility ________ and multiply the number by 2.0 . . . . . . . . . . . (i) __________ . ______

Four Star Facility ________ and multiply the number by 1.5 . . . . . . . . . . . (ii) __________ . ______

Three Star Facility ________ and multiply the number by 1.0 . . . . . . . . . . . (iii) __________ . ______

Two Star Facility ________ and multiply the number by .50 . . . . . . . . . . . (iv) __________ . ______ 3. Add lines (i) through (iv) and enter the result. Be sure to include the decimal. . . . . . . . . . . . . . . . . . . . . . 3 __________ . ______ 4. Multiply Line 1 by the total on Line 3. If the number results in a decimal, round to the nearest dollar

and enter the result here and on Form IT-540, Line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ______________ . 00 On Form IT-540, Line 14 enter in the boxes designated for 5, 4, 3, or 2 the number of your qualified dependents as shown on Line 2 above for the associated star rated facility. 2022 Louisiana Earned Income Credit Worksheet R.S. 47:297.8 allows a refundable credit for resident individuals who claimed and received a Federal Earned Income Credit (EIC). The Federal EIC is available for certain individuals who work, have a valid Social Security Number, and have a qualifying child, or are between ages 25 and 64. These individuals cannot be a qualifying child or dependent of another person. Complete only if you claimed a Federal Earned Income Credit (EIC) 1. Federal Earned Income Credit – Enter the amount from Federal Form 1040 or 1040-SR, Line 27. . . . . . . . . . . . . . . . . . . 1 . 00 2. Multiply Line 1 above by 5 percent, round to the nearest dollar, and enter the result on Line 3. . . . . . . . . . . . . . . . . . . . 2 X .05 3. Enter this amount on Form IT-540, Line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . 00 62314 Your Name Social Security Number 2022 Louisiana Refundable School Readiness Credit Worksheet (For use with Form IT-540) ATTACH THIS WORKSHEET TO YOUR RETURN IF COMPLETED. WEB

62315 2022 Louisiana Nonrefundable Child Care Credit Worksheet (For use with Form IT-540) 1 Enter Federal Child Care Credit from Federal Form 1040 or 1040-SR, Schedule 3, Line 2. NOTE: Retain copies of canceled checks, receipts and other documentation in order to support the amount of qualifying expenses. 1 .00 1A Enter the applicable percentage from the chart shown below.

Federal Adjusted Gross Income Percentage

$25,001 – $35,000 30% (.30)

$35,001 – $60,000 10% (.10)

over $60,000 10% (.10) 1A X . _______ 2 Multiply your Federal Child Care Credit shown on Line 1 by the percentage shown on Line 1A. If your Federal Adjusted Gross Income is less than or equal to $60,000, this is your available Nonrefundable Child Care Credit for 2022. Proceed to Line 3. 2 .00 2A Important! If your Federal Adjusted Gross Income is greater than $60,000, the amount on Line 2 is limited to the LESSER of $25.00, or 10 percent of the federal credit. If Line 2 is greater than $25.00, enter $25 here. This is your available Nonrefundable Child Care Credit for 2022. 2A .00 3 Enter the amount of Louisiana income tax from Form IT-540, Line 18. 3 .00 4 If Line 3 is equal to zero, your entire Child Care Credit for 2022 (Line 2 or 2A above) will be carried forward to 2023. Also, any available carryforward from 2017 through 2021 will be carried forward to 2023. If Line 3 is equal to zero, enter zero “0” on Form IT-540, Schedule J, Lines 2 and 3. Stop here; you are finished with the worksheet. 4 Use Lines 5 through 8 to determine the amount of Nonrefundable Child Care Credit Carryforward from 2017 through 2021 utilized for 2022. 5 If Line 3 above is greater than zero, enter the amount from Line 3. 5 .00 6 Enter the amount of any Child Care Credit Carryforward from 2017 through 2021. 6 .00 7 Subtract Line 6 from Line 5. 7 .00 8 If Line 7 is less than or equal to zero, the amount of Child Care Credit Carryforward used for 2022 is equal to Line 5 above. Enter the amount from Line 5 above on Form IT-540, Schedule J, Line 3. If Line 7 is less than zero, subtract Line 5 from Line 6 and enter the result here. This amount is your unused Child Care Credit Carryforward from 2017 through 2021 that can be carried forward to 2023. Also, your entire Child Care Credit for 2022 (Line 2 or 2A above) will be carried forward to 2023. Stop here; you are finished with the worksheet. 8 .00 Use Lines 9 through 13 to determine the amount of Child Care Credit Carryforward utilized from 2017 through 2021 plus any amount of your 2022 Child Care Credit. 9 If Line 7 above is greater than zero, enter the amount of carryforward shown on Line 6 above on Form IT-540, Schedule J, Line 3. 9 10 If Line 7 above is greater than zero, enter the amount from Line 7. 10 .00 11 Enter the amount of your 2022 Child Care Credit (Line 2 or Line 2A above). 11 .00 12 Subtract Line 11 from Line 10. 12 .00 13 If Line 12 is greater than or equal to zero, your entire Child Care Credit for 2022 (Line 2 or 2A above) has been utilized. Enter the amount from Line 11 above on Form IT-540, Schedule J, Line 2. Stop here; you are finished with the worksheet. 13 Use Line 14 to determine what amount of your 2022 Child Care Credit you can claim. 14 If Line 12 above is less than zero, the amount on Line 10 above is the amount of your 2022 Child Care Credit. Enter the amount from Line 10 above on Form IT-540, Schedule J, Line 2. 14 Use Line 15 to determine the amount of your 2022 Child Care Credit to be carried forward to 2023. 15 If Line 12 above is less than zero, subtract Line 10 from Line 11 to compute your Child Care Carryforward to 2023. Enter the result here and keep this amount for your records. 15 .00 ATTACH THIS WORKSHEET TO YOUR RETURN IF COMPLETED. Your Name Social Security Number WEB

2022 Louisiana Nonrefundable School Readiness Credit Worksheet (For use with Form IT-540) See instructions on page 13. 1 Enter the amount of 2022 Louisiana Nonrefundable Child Care Credit found on the Louisiana Nonrefundable Child Care Credit Worksheet on either Line 2 or Line 2A. 1 .00 2 Using the star rating of the child care facility that your qualified dependent attended during 2022, shown on Form R-10614, enter the number of your qualified dependents under age six who attended a:

Five Star Facility ________ and multiply the number by 2.0 . . . . . . . . . . . (i) __________ . ______

Four Star Facility ________ and multiply the number by 1.5 . . . . . . . . . . . (ii) __________ . ______

Three Star Facility ________ and multiply the number by 1.0 . . . . . . . . . . . (iii) __________ . ______

Two Star Facility ________ and multiply the number by .50 . . . . . . . . . . . (iv) __________ . ______ On Form IT-540, Schedule J, Line 4 enter in the boxes designated for 5, 4, 3, or 2 the number of your qualified dependents as shown above for the associ­ated star rated facility. 3 Add lines (i) through (iv) and enter the result. Be sure to include the decimal. 3 X ________________._____ 4 Multiply Line 1 by the total on Line 3. If the number results in a decimal, round to the nearest dollar and enter the result here. This is your available Nonrefundable School Readiness Credit for 2022. 4 .00 5 Enter the amount from Form IT-540, Line 18. 5 .00 6 Add the amounts of Nonrefundable credits from Form IT-540, Schedule J, Lines 2 and 3. 6 .00 7 Subtract Line 6 from Line 5. 7 .00 8 If Line 7 is less than or equal to zero, your entire School Readiness Credit for 2022 (Line 4) will be carried forward to 2023. Also, any available carryforward from 2017 through 2021 will be carried forward to 2023. If Line 7 above is less than or equal to zero, enter zero “0” on Form IT-540, Schedule J, Lines 4 and 5. Stop here; you are finished with the worksheet. Use Lines 9 through 12 to determine the amount of Nonrefundable School Readiness Credit Carryforward from 2017 through 2021 utilized for 2022. 9 If Line 7 above is greater than zero, enter the amount from Line 7. 9 .00 10 Enter the amount of any School Readiness Credit Carryforward from 2017 through 2021. 10 .00 11 Subtract Line 10 from Line 9. 11 .00 12 If Line 11 is less than or equal to zero, the amount of School Readiness Credit Carryforward used for 2022 is equal to Line 9. Enter the amount from Line 9 on Form IT-540, Schedule J, Line 5. If Line 11 is less than zero, subtract Line 9 from Line 10 and enter the result here. This amount is your unused School Readiness Credit Carryforward from 2017 through 2021 that can be carried forward to 2023. Also, your entire School Readiness Credit for 2022 (Line 4) will be carried forward to 2023. Stop here; you are finished with the worksheet. 12 .00 Use Lines 13 through 17 to determine the amount of School Readiness Credit Carryforward utilized from 2017 through 2021 plus any amount of your 2022 School Readiness Credit. 13 If Line 11 above is greater than zero, enter the amount of carryforward shown on Line 10 above on Form IT-540, Schedule J, Line 5. 14 If Line 11 is greater than zero, enter the amount from Line 11. 14 .00 15 Enter the amount of your 2022 School Readiness Credit (Line 4). 15 .00 16 Subtract Line 15 from Line 14. 16 .00 17 If Line 16 is greater than or equal to zero, your entire School Readiness Credit for 2022 (Line 4) has been utilized. Enter the amount from Line 15 on Form IT-540, Schedule J, Line 4. Stop here; you are finished with the worksheet. Use Line 18 to determine what amount of your 2022 School Readiness Credit you can claim. 18 If Line 16 is less than zero, the amount on Line 14 is the amount of your 2022 School Readiness Credit. Enter the amount from Line 14 above on Form IT-540, Schedule J, Line 4. Use Line 19 to determine the amount of your 2022 School Readiness Credit to be carried forward to 2023. 19 If Line 16 is less than zero, subtract Line 14 from Line 15 to compute your School Readiness Carryforward to 2023. Enter the result here and keep this amount for your records. 19 .00 ATTACH THIS WORKSHEET TO YOUR RETURN IF COMPLETED. Your Name Social Security Number 62316 WEB