Louisiana Department of Revenue
R-1072 (7/04)
Manufacturer’s Designation of Mandate (Agency)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, a person whose principal
(Legal name of Manufacturer)
activity is the manufacturing or producing of tangible personal property for sale and who has been assigned by the
Louisiana Department of Labor a North American Industrial Classification System (NAICS) code within the agricultural,
forestry, fishing and hunting Sector 11 or the manufacturing Sectors 31-33 as they existed in 2002, does hereby designate
the following person as its mandatary for the purpose of making purchases, leases, and rentals of manufacturing
machinery and equipment:
(Name)
(Address)
(City, State, ZIP)
This designation of mandate shall be effective for purchases, leases, and rentals of manufacturing machinery and
equipment to be used by the designating manufacturer predominantly and directly in manufacturing or producing tangible
personal property or agricultural products for sale. The manufacturing machinery and equipment will be used at a plant
facility whose address is:
(Mark one.)
❏
The designated mandatary is not restricted as to vendor.
❏
The designated mandatary is restricted to purchases from the following vendor:
The designation of mandate is for the period of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, through _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Purchases, leases, and rentals of tangible personal property during this period by the mandatary for use at this
manufacturing location shall be considered as the legal equivalent of purchases directly by the designating manufacturer.
Should such tangible personal property ultimately be used other than predominately and directly in the manufacturing of
tangible personal property or agricultural products for sale, the designating manufacturer and/or the designated mandatary
will be liable for the tax. The mandatary is not authorized to delegate this purchasing authority to others; separate
designations of mandate by the manufacturer are required for each person who is to purchase eligible manufacturing
machinery and equipment on behalf of the manufacturer. The undersigned hereby certify that this designation is the
entirety of the mandate contract between them.
Designation of Mandate:
Acceptance of Mandate:
(Signature of Authorized Designator and Date)
(Signature of Mandatary’s Authorized Acceptor and Date)
(Name of Authorized Designator)
(Name of Mandatary’s Authorized Acceptor)
(Name of Manufacturer’s Designator)
(Name of Mandatary)
(Address)
(Address)