Sales And Use Tax Report Form - Baton Rouge - Louisiana Page 2
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2This return is DUE on the 1st day of the month following the period covered by this return and becomes DELINQUENT
if not received by this office prior to the 21st day.
By signing this return, the preparer is declaring under the penalties for filing false reports that this return, including any
accompanying schedules and statements, has been examined by them and to the best of their knowledge is a true, correct,
and complete return.
Please complete any applicable information below:
State Tax ID Number
Date Out of Business
Date Business Sold
Name of New Owner
New Mailing Address
Any Company USA
1234 Main Street
Baton Rouge, LA 70801
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