State of Louisiana
Department of Revenue and Taxation
covering purchases by qualified Louisiana seafood processing facilities
exempt from certain sales, use, lease, and service tax (Revised Statute 47:305.20)
Purchaser name ________________________________________________
Exemption certificate no. __________________________________________
Expiration date _________________________________________________
City, State, ZIP _________________________________________________
La. sales tax acct. no. ____________________________________________
This certifies that certain materials, goods, merchandise, and/or services purchased by the above named from ________________________________________
1. materials and supplies purchased by the owner/operator that are necessary for repairs to the facility, or
2. materials and supplies delivered to the facility for use or consumption in the maintenance and operation thereof for processing ventures, or
3. repair services performed upon the facility, or
4. sources of energy or fuels for the facility,
and are therefore exempt from tax as provided in R.S. 47:305.20.
The above-named purchaser further agrees to assume full liability should the sale later be held subject to the tax.
Signature of purchaser
The purchaser’s exemption certificate must be presented to the vendor in order to obtain exemption. Any purchaser who fraudulently signs this certificate without
intent to use the property or services purchased as stated above will be subject to all penalties provided by R.S. 47:305.20.
NOTICE TO VENDOR: This form must be retained by you in support of the exempt sales reported on your Louisiana sales tax return.