Application for Occupational License
Make Check Payable To:
Town of Maringouin, LA (1161)
ALL FIELDS MUST BE COMPLETED
Tax Trust Account
Due:
Mail to:
January 1
RDS--LA Occupational License Tax
Delq:
March 1
9618 Jefferson Highway, Suite D #334
Baton Rouge, LA 70809
MUST Be Completed
Section 1 – Business Information
Toll Free Phone 800-556-7274
2015
Year:*
_____
____________
Toll Free Fax Number 844-528-6529
(
Lines 1 through 12 must be completed in full.)
Failure to Complete will delay License
Occupational License Tax Applicatio n
1.
Date of Application: ___/_____/_____ (Month, Day, Year)
RDS ID: ________________________
Renewal (Provide Prior Year’s License Number): _______________
2.
Application Type:
New Business
3.
FEIN/Social Security #:________________ LA Sales Tax Number: ___________________Local Sales Tax Number: _____________________
4.
Taxpayer Name: __________________________________
Trade Name/DBA: ___________________________
5.
Mailing Address: _______________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
6.
Physical Address: _____________________________________________________________________________________________________
(Street—No PO Box)
(City)
(State)
(Zip)
Email Address:________________________________________________________
Telephone No.:__________________
7.
Type of Business (Select One):
Individual
8.
Other (Specify): __________________________
(6)=Physical Address
9.
Advise Location of Accounting Records:
(5)=Mailing Address
Provide information on owner(s) below. If corporation or partnership, provide information for officers or partners. For Corporation, provide
10.
state of incorporation:
Name
Title
Social Security Number
Resident Address
Telephone Number
Name
Title
Social Security Number
Resident Address
Telephone Number
Name
Title
Social Security Number
Resident Address
Telephone Number
Provide Name and address of your agent or attorney who would be served if a suit or charges were filed:
11.
________________________________________________________________________________________________________________________
Other Description:___________________
Retail
Business Type:
Description of Sales or Activity or (Example: Retail, women’s clothing etc): ________________________________
Required: Schedule Number from Fee Schedule....see business classification list at ):__________________________
12.
Section 2 – New Businesses
(Complete this section if you are a new business. To purchase a renewal license skip to Section 3.)
New Business Check One:
New Business Started On: _____/_____/_____
13.
Purchased Existing Business-Name Previous Owner: __________________________
Other (Specify):__________________________________
14.
Check One Box Below and Follow Instructions to Calculate Taxable Gross Receipts:
Business Opened This Calendar Year
Less Than 30 Days:
Between Dec 2 & Dec 31
Total Gross Receipts for Period of Operation: ___________________
Skip to Section 4 to Calculate Tax Due
Prior to Dec 2: Pay Minimum Tax; Calculate Remainder Due After First 30 Days of Operation Using Method Immediately Below.
More Than 30 Days:
A.
Gross Receipts For First 30 Days:
____________________
B.
Deductions*:
_________________
____________________
C.
(A) Minus (B) Equals Taxable Receipts:
____________________
D.
Number of Months In Operation:
____________________
E.
(D) Times (C) Equals Est. Taxable Gross:
____________________
F.
Skip to Section 4 to Calculate Tax Due