Form R-1056 - Certificate Of Sales/use Tax Exemption/exclusion

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R-1056 (9/00)
State of Louisiana
Department of Revenue
Certificate of Sales/Use Tax Exemption/Exclusion
covering purchases by political subdivisions of the State of Louisiana
Louisiana Revised Statute 47:301(8)(c)
Date ________________________________________
The undersigned customer of _______________________________________________________________________
whose address is _________________________________________________________________________________
_______________________________________________________________________________________________
City
State
ZIP
is a public agency of Louisiana with legal status as one of the following:
(Mark one.)
State agency, board, or commission
Parish government or instrumentality thereof
Municipal government or instrumentality thereof
Parish school board or public school
Public Charter School (R.S. 17:3971-4001)
Law enforcement district
Hospital service district
Waterworks district
Public housing authority
Parish and municipal libraries
Other (List.) __________________________________________________
Purchases of tangible personal property and taxable services, and/or leases and rentals of tangible personal property
by this political body are totally exempted from the 4 percent sales tax levied by the State as provided by Louisiana
Revised Statute 47:301(8)(c). No sales/use tax is to be charged when an agency makes a purchase and is responsible
to you for payment. If the sales are later held subject to tax, we assume full liability.
_____________________________________________
_____________________________________________
Authorized signature
Name of public agency
_____________________________________________
_____________________________________________
Address
City, State, ZIP
This form is to be completed by an authorized buyer and forwarded to the seller for retention. Misuse of the certificate by
the seller or the purchaser will subject either party to the civil and criminal penalties provided by law.

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