Form R-1342 - Tax Registration Numbers And Contract Information Form
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2R-1342 (1/02)
State of Louisiana
Job # ________ /Rel dte ________
Job # ________ /Rel dte ________
Department of Revenue
Job # ________ /Rel dte ________
Tax Registration Numbers and Contract Information
This form must be completed and returned to the Depart-
Legal name _____________________________________
ment of Revenue with the completed bond form. Return this
form to:
Trade name _____________________________________
Department of Revenue
Taxpayer Services Division
______________________________________________
Business Services
Mailing address
P.O. Box 3863
______________________________________________
Baton Rouge, LA 70821-3863
City, state, ZIP
If sending by courier, use the following address:
Contact person __________________________________
617 North Third Street
Baton Rouge, LA 70804.
(
)
Telephone ______________________________________
❑
(
)
Keyed on DB
Fax ___________________________________________
A
Tax Registration Information
Complete each tax section below or check appropriate boxes.
1
Louisiana Sales and Use Tax Number
(Application enclosed, if applicable.)
❑
❑
None
Applied for
–
❑
(Attach application.)
Not required
Explain ________________________________________
2
Louisiana Income/Withholding Tax Number
(Application enclosed, if applicable.)
❑
❑
None
Applied for
–
❑
(Attach application.)
Not required
Explain ________________________________________
3
Louisiana Corporate Income/Franchise Tax Number
(Application enclosed, if applicable.)
❑
❑
None
Applied for
–
❑
(Attach application.)
Not required
Explain ________________________________________
4
Social Security Number for Individual Income Tax
❑
❑
None
Applied for
–
–
❑
Not required
Explain ________________________________________
5
Louisiana Unemployment Insurance Tax Account Number
❑
❑
None
Applied for
❑
Not required
Explain ________________________________________
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