Form R-1342 - Tax Registration Numbers And Contract Information Form Page 2
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1
2B
Contracts
1
For office Cert. # ____ -B- ________
Contract 1
use
Bond # _______________
1. Name/Description
2. Location
Street address
City
Parish
❑
❑
3. Is this contract located within the limits of a municipality?
Yes
No
If yes, please list the municipality
4. Estimated beginning date of contract (month/date/year):
5. Estimated ending date of contract (month/date/year):
6. Estimated contract price: $ ________________________
7. Five percent of Line 6 or $1,000, whichever is greater:
$ ________________________
This is the amount of the bond you are required to obtain for this contract.
2
For office Cert. # ____ -B- ________
Contract 2
use
Bond # _______________
1. Name/Description
2. Location
Street address
City
Parish
❑
❑
3. Is this contract located within the limits of a municipality?
Yes
No
If yes, please list the municipality
4. Estimated beginning date of contract (month/date/year):
5. Estimated ending date of contract (month/date/year):
6. Estimated contract price: $ ________________________
7. Five percent of Line 6 or $1,000, whichever is greater:
$ ________________________
This is the amount of the bond you are required to obtain for this contract.
3
For office Cert. # ____ -B- ________
Contract 3
use
Bond # _______________
1. Name/Description
2. Location
Street address
City
Parish
❑
❑
3. Is this contract located within the limits of a municipality?
Yes
No
If yes, please list the municipality
4. Estimated beginning date of contract (month/date/year):
5. Estimated ending date of contract (month/date/year):
6. Estimated contract price: $ ________________________
7. Five percent of Line 6 or $1,000, whichever is greater:
$ ________________________
This is the amount of the bond you are required to obtain for this contract.
Attach additional sheet, if required. (Duplicate this page.)
C
Registration Fees
Number of contracts ______________
A $10.00 registration fee is assessed for each contract that you
have entered into since July 6, 1984, in Louisiana. To determine
x $10.00
______________
the required amount of registration fees, multiply the total number
of contracts listed by $10.00. Make payment to Department of
Total registration fees = ______________
Revenue. Do not send cash.
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