Certificate Of Governmental Exemption From Payment Of Hotel Occupancy Taxes And Hotel Sales Taxes

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BC 1376 (12/02)
PHONE: (318) 741-8551
FAX: (318) 741-8997
Certificate of Governmental Exemption from Payment of Hotel Occupancy Taxes
and Hotel Sales Taxes
For use by employees of the government of the United States and the State of Louisiana and its political subdivisions in
documenting eligibility for exemption from the payment of local occupancy and sales taxes on hotel lodging charges that are
directly reimbursable by their government employers
This certifies that __________________________________________________________________________________
Name and title of employee
is an employee of __________________________________________________________________________________
Name of government employer
whose address and telephone number are ____________________________________________________________
Street
____________________________________________________ ____________________________________________
City, State, ZIP
Telephone
and that the lodging charges incurred by the employee at the ___________________________________________
Name of hotel
during the period _________________________________________________________________________________
Date of employee’s stay
are necessitated by the employee’s conduct of the official business of this government agency. The employee’s lodging
expenses are required to be accounted for to the government agency employer and are reimbursable by the employer to
the employee in the actual amount incurred. This government agency, therefore, claims exemption from the payment of
occupancy taxes and sales taxes on the charges for the occupancy of the employee’s hotel room.
___________________________________________ ______________________________________ ______________
Name and title of employee
Signature
Date
___________________________________________ ______________________________________ ______________
Name and title of employer representative directing travel
Signature
Date
This form is usable only in documenting eligibility for exemption from the payment of local occupancy tax and sales tax
on charges for room occupancy. The local sales tax must be paid on other taxable purchases from the hotel, including
meals, laundry, dry cleaning and vehicle parking. When this form bears the signature of only the government employee,
the form must be accompanied by a copy of the employee’s written travel orders, in which the government employer
directs a stay at the specific hotel accepting the form, or alternatively, at any hotel within a narrowly defied geographic
area. The hotel must retain this certificate with a photocopy of the travel orders to document the exemption.

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