Form R-1070 - Application For Certification As A "Manufacturer" Form - Louisiana Department Of Revenue

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R-1070 (6/04)
Louisiana Department of Revenue
Application for Certification as a “Manufacturer”
in accordance with Louisiana Revised Statute 47:301(3)(i),
for Exclusion of Louisiana State Sales Tax on Purchases, Importations, and
Leases or Rentals of Qualified Manufacturing Machinery or Equipment
For additional information, see Revenue Information Bulletin 04-012 on our website at
Legal Name:
Trade Name:
Location Address:
City, State, ZIP:
Mailing Address:
City, State, ZIP:
Contact Person:
Telephone Number:
Louisiana Tax Account Identification Number for this location:
Sales: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Withholding: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Louisiana Department of Labor Employer Account File Number: __________________________________________________
North American Industrial Classification System Code (NAICS), as issued by the Louisiana Department of Labor:
__________________________________________________________________________________________________________
Description of Business: (Attach additional sheet(s) if necessary.) ________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Finished goods produced:
__________________________________________________________________________________
__________________________________________________________________________________________________________
Signature of Owner/Officer
Title
Submit to:
Louisiana Department of Revenue
Taxpayer Services Division
P.O. Box 201
Baton Rouge, LA 70821-0201

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