Gretna Tav Application Form - Jefferson Parish Sheriff'S Office
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1
2Jefferson Parish Sheriff's Office
HARRY LEE
1. Date of Application
Bureau of Revenue & Taxation
Sheriff and Tax Collector
P. O. Box 248
Telephone: (504) 376-2459
Day
Year
Gretna, La 70054-0248
Month
Fax: (504) 376-2469
APPLICATION FOR
FOR OFFICE USE ONLY
(Check one or more squares)
FOR OFFICE USE ONLY
A.
Sales/Use Tax Registration
2.
B.
Occupational License Tax
3. Class
C.
Chain Store Tax
(OLT)
D.
General Registration
C.R.N.
4. SIC
(Sales)
5.
Federal Employer ID Number
None
6. LA Sales Tax Number
None
7. Local Sales Tax Number
None
8. A. Taxpayer Name Corporate Name
B. Trade Name
C Mailing Address - Include City. State. Zip Code
D. Area Code - Phone Number
E. Business Location-Street. City. State, Zip Code
F. Phone Number – Location
9. Type of Organization
A.
Individual
B.
Partnership
C.
Corporation
D.
Governmental
E.
Non-Profit
F.
Other (Specify)
Title
10. If corporation or
Name
SSN
partnership Name.
Title, Soc. Sec. No.,
Resident Address, City, State, Zip Code
Phone
Resident Address
And Phone of
Name
Title
SSN
Officers or
Partners.
Resident Address, City, State, Zip Code
Phone
Name
Title
SSN
Resident Address, City, State, Zip Code
Phone
11. If Sole Owner (individual) Name
SSN
Resident Address, City, State, Zip Code
Phone
12. Number of Professional
13. Name and Address for Service of Process
14. Location of Accounting Records-Check One as Noted in
Members in Firm
Item 8
C
E (If other, indicate address, city, state & zip code)
15. If Corporation, State
16. Reason
A.
Started New Business
C.
Other (specify)
of Incorporation
for
B.
Purchased Going Business—Name of previous Owner
Applying
17. Date Business Started/
18. Have You Recorded Your Trade
19. (A) How Many Other Business Locations Do You Have In
Acquired at THIS LOCATION
This Parish and/or Municipal?
Name With the Jefferson
(B) INCLUDING This Location, How Many Retail Business
Parish Clerk of Court?
Locations Do You Have Nationwide?
If Greater Than One (1) Complete Chain Store Tax (Line 28 of Sch.A)
Month
Day
Year
Yes
No
20.
Nature
Description of Sales of Activity
of
Business
Does Business Activity Include the Sale of Food or Beverages?
Yes
No
If Yes, Attach Copy of Approval Issued by the Jefferson Parish Health Unit.
COMPLETE REVERSE SIDE TO DETERMINE AMOUNT DUE $
I affirm that the information
Signature of Applicant
Title
Given on this application and
Attached schedules is true
Signature of Preparer
and correct
if different from above
PLEASE REFER TO INSTRUCTIONS - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
LMA-001
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Parent category: Financial