Form R-1013 - For-Hire Carrier Blanket Certificate - State Of Louisiana Department Of Revenue

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LGST-12
R-1013 (8/ 98)
State of Louisiana
Department of Revenue
P. O. Box 201 Baton Rouge, LA 70821-0201
For-Hire Carrier Blanket Certificate
for use by for-hire carriers operating in interstate or foreign commerce
under the Louisiana sales tax law (Louisiana Revised Statute 47:301 et seq.)
Date ____________________________________ , _________
Year
This certifies that all materials, equipment, goods, or merchandise purchased by the undersigned from:
Name
_________________________________________________________________________________________________________
Address _________________________________________________________________________________________________________
City, State, ZIP ____________________________________________________________________________________________________
are to be used or consumed in the undersigned’s business of transporting passengers or property for hire in interstate or foreign commerce, and
that all tax due will be paid by the undersigned directly to the Department of Revenue, under the provisions of R.S. 47:306.1, as amended. The
undersigned further certifies that this tax treatment has been elected by the taxpayer.
Registration cer tificate number _______________________________________________________________________________________
Signature of purchaser ______________________________________________________________________________________________
Address __________________________________________________________________________________________________________
City, State, ZIP ____________________________________________________________________________________________________
Any purchaser who fraudulently signs this certificate without intent to use the proper ty or services purchased as stated above will be subject
to all penalties provided by law. This certificate may not be offered or accepted in lieu of the tax on lease or rental transactions or on repair or
other service transactions.

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