Form R-1012 - Application For Exemption And Direct Payment Authorization For A Call Center As Defined Under Louisiana Revised Statute - Sales Tax Division Of Department Of Revenue Of State Of Louisiana

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State of Louisiana
R-1012 (2/01)
Department of Revenue
Sales Tax Division
P.O. Box 201
Baton Rouge, LA 70821-0201
Application for Exemption and Direct Payment Authorization
for a Call Center as defined under
Louisiana Revised Statute 47:301(14)(i)(ii)(cc)(III)
Name __________________________________________________________________________________________
Mailing Address __________________________________________________________________________________
City, State, ZIP __________________________________________________________________________________
Location Address(es) (Attach additional pages if necessary.)
Louisiana Business Master File Account Number
Describe the principal income producing activity of your business
On the lines below, list the names, addresses, and Business Master File Account Numbers of your subsidiaries that
operate as call centers in Louisiana. (Add additional pages if necessary.)
Print/type name of authorized officer ________________________ Title ___________________________________
Signature of authorized officer _____________________________ Date ___________________________________
Telephone __________________________________________

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