Form R-1340 - Certification Of Resident/nonresident Status By Contractors And Subcontractors Working In The State

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R-1340 (12/01)
State of Louisiana
Department of Revenue
Certification of Resident/Nonresident Status
by Contractors and Subcontractors Working in the State
(Louisiana Revised Statute 47:9)
❑ New
❑ Renewal
Please return to the Department of Revenue,
Taxpayer Services Division, Post Office Box 3863, Baton Rouge, LA 70821-3863
1. Legal name
__________________________________________________________________________
2. Trade name (if any)
__________________________________________________________________________
3. Mailing address
__________________________________________________________________________
__________________________________________________________________________
(
)
4. Daytime telephone
__________________________________________________________________________
5. If you are currently registered with the Louisiana Department of Revenue for the following taxes, please list your 10-digit
account numbers.
Sales Tax
Withholding Tax
Corporation Income/Franchise Tax
❏
6. Type of Organization:
Partnership
❏
Corporation
Date of incorporation __________________________________________
❏
Individual
Social Security Number ________________________________________
❏
Other
Please specify. _______________________________________________
❏
❏
7. Have you been actively engaged at any time since July 6, 1984, in performing work on contracts in Louisiana?
Yes
No
If you acknowledge that you are a nonresident contractor or subcontractor who is subject to the contract registration and
❏
bonding requirements of R.S. 47:9 et al., please mark this box.
If you claim not to be subject to the contract registration and bonding requirements of R.S. 47:9, you must answer
questions 8-12. Other contractors and subcontractors who have marked the above block can disregard the questions
and need only sign and date the questionnaire on the reverse side.
8. Have the owners of this business been permanent residents of Louisiana for at least one year prior to bidding on work
❏
❏
in Louisiana?
Yes
No
If “yes”, please list the Louisiana location address of each owner that has been his permanent residence for the past
year. If any owners have had more than one permanent address in the past year, please list all of them, including the
dates of change. Do not list post office boxes.
❏
❏
9. Do you currently operate any permanent business facilities in Louisiana?
Yes
No
If “yes”, please indicate the total number of your permanent business facilities in Louisiana.
Questionnaire continued on reverse side

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