Form R-1342 - Tax Registration Numbers And Contract Information Page 2
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1
2B Contracts
Cert. #
-B-
1.
Contract 1
For Office Use
Bond #
1.
Na
me/Description ____________________________________________________________________________________
2.
Location
___________________________________________________________________________________________
S t re e t Ad d re s s
C i t y
Pa r i s h
■
■
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
: _________________________________________________________
(MM/DD/YYYY)
5.
Estimated ending date of contract
(MM/DD/YYYY): __________________________________________________________________________
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.
Cert. #
-B-
2.
Contract 2
For Office Use
Bond #
1.
Na
me/Description ____________________________________________________________________________________
2.
Location
___________________________________________________________________________________________
S t re e t Ad d re s s
C i t y
Pa r i s h
■
■
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
: _________________________________________________________
(MM/DD/YYYY)
5.
Estimated ending date of contract
(MM/DD/YYYY): __________________________________________________________________________
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.
Cert. #
-B-
3.
Contract 3
For Office Use
Bond #
1.
Na
me/Description ____________________________________________________________________________________
2.
Location
___________________________________________________________________________________________
S t re e t Ad d re s s
C i t y
Pa r i s h
■
■
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
: _________________________________________________________
(MM/DD/YYYY)
5.
Estimated ending date of contract
(MM/DD/YYYY): __________________________________________________________________________
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 sheets, if required. (Duplicate this page.)
C Registration Fees
A $10.00 registration fee is assessed for each contract that
Number of contracts
you have entered into since July 6, 1984, in Louisiana. To
x
$10.00
determine the required amount of registration fees, multiply the
total number of contracts listed by $10.00. Make payment to
Total registration fees =
Louisiana Dept. of Revenue. Do not send cash.
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