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ASCENSION PARISH SALES AND USE TAX AUTHORITY

1234567

Account No.

SALES AND USE TAX REPORT

Make remittance Payable To:

MONTH

2 digit

Ascension Parish Sales Tax Authority

03 = 1Q, 06 = 2Q, etc.

Donaldsonville 225-473-8630

P.O. Box 389,

Fax 225-473-5792

Donaldsonville, LA 70346

YEAR

4 digit

(Do Not use any other taxpayer's return as this will result in improper credit.)

Gonzales 225-621-2635

Fax 225-621-2644

1.GROSS SALES OF TANGIBLE PERSONAL PROPERTY, LEASES, RENTALS, AND SERVICES

SCHEDULE "A" ALLOWABLE DEDUCTIONS

2. SALES FOR RESALE OR FURTHER PROCESSING (RESALE CERTIFICATE ON FILE)

3. CASH DISCOUNTS, SALES RETURNS & ALLOWANCES

TAX INCREASE!

4. SALES DELIVERED OR SHIPPED OUTSIDE THIS JURISDICTION (DOES NOT APPLY TO REPAIRS)

BEGINNING JULY 1,2001

5. SALES OF GASOLINE AND MOTOR FUELS

COLUMN A IS 4 1/2%

6. SALES TO US GOV'T, STATE OF LA, POLITICAL SUBDV. & LOCAL AGENCIES

7. SALES OF FOOD PAID WITH USDA FOOD STAMPS OR WIC VOUCHERS

OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)

11. TOTAL ALLOWABLE DEDUCTIONS (LINE 2 THRU 10)

12. ADJUSTED GROSS SALES (LINE 1 MINUS LINE 11)

COMPUTATION OF SALES AND USE TAX

COMPLETE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS

ASCENSION PARISH SCHOOL BOARD (Entire Parish, All Columns)

4 1/2%

4 1/2 %

4 1/2%

4/1/2

ASCENSION PARISH GOVERNMENT (Rural Tax, Column C &E)

EAST

WEST

EAST

WEST

CITY OF GONZALES (within city limits, Column A)

ASCENSION

CITY OF DONALDSONVILLE (within City limits, Column D)

ASCENSION

WITHIN

TOWN OF SORRENTO (within Town limits, Column B)

NOT IN

WITHIN

.5% ASCENSION PARISH SHERIFF (rural areas, Column C & E)

GONZALES OR

DONALDSONVILLE

SORRENTO

GONZALES

.5% EAST ASCENSION DRAINAGE DISTRICT (Columns A, B, & C)

SORRENTO

.5% WEST ASCENSION HOSPITAL (Column D & E)

.5 % ASCENSION PARISH DISTRICT # 2 (rural areas, Columns C & E)

13. ADJUSTED GROSS SALES IN EACH JURISDICTION

14.PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION

15. TOTAL TAXABLE TRANSACTIONS (LINE 13 PLUS LINE 14)

16. TAX DUE (MULTIPLY LINE 15 BY THE TAX RATE OF EACH COLUMN)

17. EXCESS TAX COLLECTED

18. TOTAL TAX DUE (LINE 16 PLUS LINE 17)

19. VENDORS COMPENSATON (2% LINE 18)

( ONLY IF PAYMENT IS NOT DELINQUENT)

20. NET TAX DUE (LINE 18 MINUS LINE 19)

21. PENALTY

)

(5% of Tax for each 30 Days or Fraction Thereof, 25%Max

22. INTEREST

(1 1/4% PER MONTH CALCULATED FROM DATE DUE UNTIL PAID)

23. TOTAL TAX, PENALTY, AND INTEREST DUE (SUM OF LINE 20-22)

24. TAX DEBIT OR CREDIT

(AUTHORIZED MEMO MUST BE ATTACHED)

25. TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)

26. TOTAL REMITTED (TOTAL OF LINE 25 COLUMNS A,B,C,D,E)

HAVE YOU USED THE PROPER COLUMN?

I declare under the penalties for filing false reports that this return (including any accompanying schedules and statements) has been examined by me and to the best of my

knowledge and belief is a true, correct, and complete return. If the return is prepared by a person other than this taxpayer, his declaration is based on all the information relating

to the matters required to be reported in the return of which he has any knowledge.

This return is DUE on the 1st day of the month following the period covered by this return and becomes DELINQUENT if not received by this office prior to the 21st day.

DATE PREPARED

SIGNATURE OF INDIVIDUAL OR AGENT & PHONE NUMBER

SIGNATURE OF PREPARER & PHONE NUMBER

CHECK NUMBER

Phone Number for Contact Person

Reviewed By

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Account No.

_____-_____-________x______

PLEASE INDICATE ANY CHANGES BELOW

Date out of business

Date business sold