R-1376 (2/98)
State of Louisiana
Department of Revenue
Certificate of Governmental Exemption
from the Payment of Hotel Lodging Taxes
for use by employees of the government of the United States and the State of Louisiana
and its political subdivisions in documenting eligibility for exemption from payment of state sales
taxes on hotel lodging charges that are directly reimbursable by their government employers
This certifies that _____________________________________________________________________
Name and title of employee
is an employee of ____________________________________________________________________
Name of government employer
whose address and telephone number are ________________________________________________
Street
(
)
________________________________________
_______________________________________
City, State, ZIP
Telephone
and that the lodging charges incurred by the employee at the _________________________________
Name of hotel
during the period _____________________________________________________________________
Dates of employee’s stay
are necessitated by the employee’s conduct of the official business of this government agency. The
employee’s lodging expenses are required to be accounted for to his government agency employer and
are reimbursable by the employer to the employee in the actual amount incurred. This government agency,
therefore, claims exemption from the payment of lodging taxes on the charges for the occupancy of the
employee’s hotel room.
____________________________________________________
_____________________________________________________
_______________________
Name and title of employee
Signature
Date
____________________________________________________
_____________________________________________________
_______________________
Name and title of other employee representative
Signature
Date
This form is usable only in documenting eligibility for exemption from the payment of state sales tax on
charges for room occupancy. The state sales tax must be paid on other taxable purchases from the hotel,
including meals, laundry, dry cleaning, and vehicle parking. When this form bears the signature of only the
employee, the form must be accompanied by a copy of the employee’s written travel orders, in which the
government employer directs a stay at the specific hotel accepting the form, or alternatively, at any hotel
within a narrowly defined geographic area. The hotel must retain this certificate and a photocopy of the
travel orders to document the exemption. This form is not valid to document exemption from the
payment of local room occupancy taxes.