Form R-16019 Cr 1 - Application For Louisiana Tax Number
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1R-16019 (1/00)
State of Louisiana
CR 1
1500
Department of Revenue
P.O. Box 201
Date of application _________________
Baton Rouge, LA 70821-0201
For office use only.
Application for Louisiana Tax Number
Sales/Use
Withholding*
Vehicle Rental Excise
1.A.
B.
C.
D.
NOEHA Additional Hotel & Food/Beverage
E.
Other _________________________________
Please print or type all information on this form. Call (225) 925-7318 for assistance. You must complete an application for a sales tax
number for each location.
2.
Reason for applying
A.
Started new business
C.
Other (specify) _________________________________
B.
Purchased going business: Name of previous owner
_________________________________
3.
A. If you are presently filing tax forms with the Louisiana Department of Revenue for a business, please indicate the account
number you use for each tax.
LA Corp. Tax Number
None
LA Sales Tax Number None
LA Withholding Tax Number None
(
)
B. How many other locations in LA _____
C. Telephone number at business
_______________________________
4.
A. Legal name(s)
Individual, partners, or corporation
B. Trade name of business
5.
A. Business location address
(Street, route, or highway – NOT P.O. Box or General Delivery)
B. City and state
C. ZIP
6.
A. Address for receiving tax forms and correspondence
(If same as location, write “Same.”)
B. City and state
C. ZIP
D. Telephone number if different from number at
location (
)
7.
Type of organization: A.
Individual
B.
Partnership
C.
Corporation
D.
Governmental
E.
Nonprofit
F.
Other
_________
_________
________
8.
Federal Standard
9.
Federal Employer
None
Industrial Code if known
ID Number
10. If sole owner (individual): Name
SSN
Home address
Telephone (
)
11. If corporation or
Name
Title
SSN
partnership: name,
Address
title, Social Security
Telephone (
)
Number, home
Name
Title
address, and
SSN
telephone number of
Address
Telephone (
)
officers or partners
12. A. Louisiana Charter Number (if known)
B. State of incorporation if not Louisiana
13. Permits – If you sell liquor, beer, or wine (wholesale or retail), you must obtain a permit from the Office of Alcohol and Tobacco
Control. If you now hold a STATE permit, indicate the permit number and the month and year in which the permit expires. Failure to
register with the Department of Revenue and/or failure to properly remit taxes can result in the loss of your state permit. If you sell
lottery tickets or have video poker games, you must obtain a permit from the Louisiana State Police Gaming Division.
A. Lottery __________________________
B. Expiration Month/Year _____________
Alcohol __________________________
_______________________________
VPG ____________________________
_______________________________
Mo. Day
Yr.
Domestic
Foreign
Fiscal Month
14. A. Corporation Income/Franchise: Date charter filed with Louisiana Secretary of State
B.
C.
15. Sales/NOEHA/Veh. Rental: Date business begins operation from this location
16. Sales or Use Tax: Date business begins operation from this location
OFFICE USE ONLY: BC
*
17.
Withholding Tax:
Select filing frequency.
quarterly
monthly
semi-monthly
(See instructions.)
18. Describe in detail your business: type of sales, activity, or service you perform. _______________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Signature of applicant
Title
I affirm that the information
________________________________________________________________________________
given on this application is true
Signature of preparer
Date
and correct.
________________________________________________________________________________
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