R-1059 - Sales Tax Exemption Certificate For Boys State Of Louisiana, Inc. And Girls State Of Louisiana, Inc.

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R-1059 (7/16)
Louisiana Department of Revenue
Sales Tax Exemption Certificate for Boys State of
Revenue Processing Center
Louisiana, Inc. and Girls State of Louisiana, Inc.
P.O. Box 4998
Baton Rouge, LA 70821-4998
Revised Statutes 47:301(7)(g), (10)(r), and (18)(f)
Phone: (855) 307-3893
PLEASE PRINT OR TYPE
Organization Name
Local Address
City
State
ZIP
Mailing Address
City
State
ZIP
Telephone Number
• Revised Statutes 47:301(7)(g), (10)(r), and (18)(f) provides sales tax exclusions for Boys State of Louisiana, Inc. and Girls State of
Louisiana, Inc.
• The sales tax exclusion is for leases or rentals and purchases for the organization’s educational and public service programs for
youth.
Qualifying purchases are subject to state sales tax at rates as shown in the box below.
Applicable State Sales Tax Rates
From
To
Rate
4/1/16
6/30/16
5%
7/1/16
3/31/19
0%
Notice to Dealer: Report this sale under exemption code 1019.
Under penalty of perjury, I declare that I have examined this exemption certificate and accompanying documents, and to the
best of my knowledge and belief, it is true, correct, and complete.
Name and title of officer entitled to make purchases on behalf of the organization.
Name
Title
Officer of the organization completing this exemption certificate.
Print/Type Name
Title
Signature
Date (mm/dd/yyyy)
Questions about the completion of this form should be sent to Sales.Inquiries@la.gov.

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