Form Lgst 9-D - Sales Tax Exemption Certificate
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1State of Louisiana
LGST 9-D
R-1096 (4/03)
Department of Revenue
Sales Tax Exemption Certificate
(Offshore Purchasers)
R.S. 47:305(I) and R.S. 47:305.10
Date
______________
Purchaser:
Address:
City
State
Zip Code
Louisiana Sales Tax Account Number:
The purchaser named above certifies that the purchase of the following tangible personal property or repair service from
the vendor identified below is for use in the Outer Continental Shelf waters, beyond the territorial boundaries of Louisiana:
The tangible personal property purchased from the vendor is for first use in the offshore area at the following location:
Area Name
Block Number
Lease Number
Description of property:
The repair service and/or parts, materials and supplies purchased from the vendor is for repairing, renovating or con-
verting a drilling rig or its component machinery and equipment parts, which are for use exclusively outside the territorial
limits of Louisiana in the Outer Continental Shelf waters.
Name and address of vendor making sale
Signature of purchaser
Title
Any purchaser and/or agent who fraudulently signs this certificate without intent to use the property purchased as stated
above is subject to all the penalties provided for by Title 47 of the Louisiana Revised Statutes of 1950. If the property is sub-
sequently returned to Louisiana for use for a taxable purpose, Louisiana use tax shall be due as of the time it is brought in
to the state.
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