2340 search results for k
- R-540INS 2016
- https://ldi.la.gov/docs/default-source/documents/citizensrebate/r-540ins-2016.pdf?sfvrsn=3f3e7752_6
- knowledge, it is true and complete. Declaration of paid preparer is based
on all available information. I
- Surplus Form 1265
- https://ldi.la.gov/docs/default-source/documents/financialsolvency/Surplus-Lines/surplus-form-1265.pdf?sfvrsn=69d37c52_18
- pursuant to La. R.S.
22:433, to the best of the affiant’s knowledge, information and belief.
See
- Form 1262.1 2018 Alien Producer Production Report
- https://ldi.la.gov/docs/default-source/documents/taxes/form-1262---alien-2017.pdf?sfvrsn=18217452_13
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- Form 1262.1 2018 Foreign Producer Production Report
- https://ldi.la.gov/docs/default-source/documents/taxes/form1262-foreign2017.pdf?sfvrsn=f217452_24
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- Form 1262.1 2019 Alien Producer Production Report
- https://ldi.la.gov/docs/default-source/documents/financialsolvency/surplus-lines/form-1262-1---alien-2019.pdf?sfvrsn=8ffb4f52_0
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- Form 1262.1 2019 Foreign Producer Production Report
- https://ldi.la.gov/docs/default-source/documents/financialsolvency/surplus-lines/form-1262-1---foreign-2019.pdf?sfvrsn=7ff84f52_0
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- LA DPS OMV Vehicle Application Form
- https://ldi.la.gov/docs/default-source/documents/propertycasualty/la-dps-omv-vehicle-application-form.pdf?sfvrsn=14424d52_0
-
VIN Make License No. Exp. Date
Body Color Year
If yes, what ward or district?
Domicile Code
Name
Street Trade VIN
Trade License No.
New
Used
State Less Trade
Tax Value
BE SURE TO SIGN AND DATE
I do swear or affirmthattheinformationcontained in thisdocument is true and
correct to the best of my knowledge.
If thevehicle being registered is defined as acommercialmotorvehicle by the
FederalMotorCarrierSafetyRegulationsand/orFederalHazardousMaterial
Regulations, by signature below
- Form 1262 1 - Foreign 2021
- https://ldi.la.gov/docs/default-source/documents/financialsolvency/surplus-lines/form-1262-1---foreign-2021.pdf?sfvrsn=29f54d52_18
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- Form 1262 1 - Alien 2021
- https://ldi.la.gov/docs/default-source/documents/financialsolvency/surplus-lines/form-1262-1---alien-2021.pdf?sfvrsn=39f54d52_12
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS
- Form1262-Alien
- https://ldi.la.gov/docs/default-source/documents/taxes/form1262-alien.pdf?sfvrsn=619f7252_28
- , and 436 to the best of
my knowledge, information, and belief:
Officer of Insurer
Date
ADDRESS