Tax Credit Request Form – Shreveport Pregnancy Center

Email

Name

First Name

Last Name

Spouse's First and Last Name (IF APPLICABLE AND FILING JOINTLY)

First Name

Last Name

Phone

Street Address (Or P.O.Box) Please Include City, State and Zipcode

Please use my contact information to update my donor file for important updates. Life Choices will never share your information with others.

Please send me Louisiana Department of Revenue Form R-90156 for donations I have made to Life Choices.

Please specify the time period (within 2025) for which you are requesting donation receipt.

Please list the date and amount of the specific donation noted in the above question