Form R-1362s - Sales Tax Refund Schedule Disaster Loss Of Tangible Personal Property

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LGST-D-76
R-1362S (9/05)
Sales Tax Refund Schedule
Disaster Loss of Tangible Personal Property
Taxpayer name ____________________________________________________ Social Security Number ____________________________________________
Nature of disaster __________________________________________________ Date of disaster __________________________________________________
Location where property was destroyed
Street
__________________________________________________________ City, parish, state ________________________________________________
Cost of Property Destroyed
Note: Cost of property applicable to Columns A, B, and C must be
shown separately; otherwise, the refund will be computed at the 2
Column A
Column B
Column C
percent sales tax rate.
Purchased prior to 7/29/70
Purchased between
Purchased subsequent to
7/29/70 – 7/1/84
7/1/84
1. Personal Property
__________________
__________________
__________________
$
$
$
A. Furniture, rugs, drapes, utensils, etc. ..............................................
__________________
__________________
__________________
$
$
$
B. Clothing, eye glasses, linen, etc.......................................................
__________________
__________________
__________________
$
$
$
C. Recreation equipment (TV, radio, camera, toys, etc.) ......................
F. Other
______________________________________
______________________________________
__________________
__________________
__________________
$
$
$
______________________________________ ..............
__________________
__________________
__________________
$
$
$
2. Total - Lines 1A through 1F....................................................................
__________________
$
3. Less: A. Insurance proceeds (actual or anticipated) ..........................
__________________
$
Apply amount under Line 3C proportionately to Columns A, B, and C
B. Proceeds from employer or disaster relief agencies ............
(cost of property) if amount is shown in more than one column.
__________________
$
C. Total – Add Lines 3A and 3B ................................................
__________________
__________________
__________________
$
$
$
4. Disaster loss – Line 2 less Line 3C ......................................................
x 2%
x 3%
x 4%
5. Sales tax rate applicable........................................................................
__________________
__________________
__________________
$
$
$
6. Refund due – Calculate Columns A, B, and C separately ....................
__________________
$
7. Total refund due – Add Columns A, B, and C of Line 6 ........................
.
To have this refund deposited to your banking account, please complete the following information
Routing Number
Account Number
❑
❑
Routing Number The first 2 digits of the routing
Type of Account:
Checking
Savings
number must be 01 through 12 or 21 through 32.
(Check one.)

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