Form R-1342 - Tax Registration Numbers And Contract Information

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R-1342 (11/08)
Job #
/Rel dte
Tax Registration Numbers and
Job #
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Contract Information
Job #
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This form must be completed and returned to the Department of Revenue with the completed bond form. Return this form to:
Louisiana Department of Revenue, Taxpayer Services Division, P.O. Box 4998, Baton Rouge, LA 70821-4998
If sending by courier, use the following address:
Louisiana Department of Revenue, 617 North Third Street, Baton Rouge, LA 70802
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Keyed on DB
PLEASE PRINT OR TYPE.
Legal Name
Trade Name
Mailing Address
City
State
ZIP
Contact Person
Telephone
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.)
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None
–
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Applied for (Attach application.)
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Not required Explain ____________________________________________
2.
Louisiana Income/Withholding Tax Number
(Application enclosed, if applicable.)
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None
–
■
Applied for (Attach application.)
■
Not required Explain ____________________________________________
3.
Louisiana Corporate Income/Franchise Tax Number
(Application enclosed, if applicable.)
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None
–
■
Applied for (Attach application.)
■
Not required Explain
4.
Social Security Number for Individual Income Tax
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None
–
–
■
Applied for (Attach application.)
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Not required Explain ____________________________________________
5.
Louisiana Unemployment Insurance Tax Account Number
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None
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Applied for (Attach application.)
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Not required Explain ____________________________________________

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