Form R-1341a - Contract Completion Form - 2002

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State of Louisiana
R-1341A (1/02)
Job number _________________________
Department of Revenue
Bond number _______________________
Release date ________________________
Contract Completion Form
1.
Contractor/Subcontractor name ________________________________________________________________
2.
Mailing address ____________________________________________________________________________
City, State, ZIP _____________________________________________________________________________
(
)
3.
Representative name __________________________________
Telephone _________________________
4.
Description and location of facility altered, renovated, or erected
_________________________________________________________________________________________
Description (type of building, name, etc.)
_________________________________________________________________________________________
Location (street, city, and parish)
Beginning date _____________________________
Ending date __________________________________
5.
Original estimated contract amount _____________________________________________________________
6.
Actual contract amount (if different from Line 5) ___________________________________________________
7.
Amount awarded to subcontractors
Resident $ _________________________________________________
Nonresident $ ______________________________________________
Please provide updated list of subcontractors. (See Form R-1130-L, General Contractor/Subcontractor List.)
Sales and Use Tax
8.
Construction materials cost
_________________________________________________
(Do not include taxes paid.)
8a.
Cost of materials purchased out of state
______________________________________
(Do not include taxes paid.)
8b.
Tax paid to another state on 8a __________________________
____________
__________________
Tax amount
Rate
State
9.
Equipment cost
__________________________________________________________
(Do not include taxes paid.)
9a.
Cost of equipment purchased out of state
_____________________________________
(Do not include taxes paid.)
9b.
Tax paid to another state on 9a __________________________
____________
__________________
Tax amount
Rate
State
10.
Equipment rentals __________________________________________________________________________
10a.
Tax paid to another state on 10 __________________________
____________
__________________
Tax amount
Rate
State
11.
Total Louisiana tax (state and local) paid on construction materials, equipment, rentals
_________________________________________________________________________________________
12.
Total Louisiana state tax paid on construction materials, equipment, rentals
_________________________________________________________________________________________
13.
Total Louisiana local tax paid on construction materials, equipment, rentals
(total of city, parish, police jury, school board, etc.)
_________________________________________________________________________________________
14.
Amount of tax paid directly to the State of Louisiana _______________________________________________
Account number __________________________________
15.
Amount of tax paid directly to the local taxing authorities
(Please identify to whom the tax was paid.)
__________________________
____________________________
__________________________
Authority
Account number
Amount
__________________________
____________________________
__________________________
Authority
Account number
Amount
__________________________
____________________________
__________________________
Authority
Account number
Amount
16.
Amount of tax paid to vendors _________________________________________________________________
State _____________________________________
Local _______________________________________

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