Form R-1377 - Direct Payment Sales Tax Application - Louisiana Department Of Revenue

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R-1377 (7/08)
Direct Payment Sales Tax Application
R.S. 47:303.1
Mail completed application to:
Louisiana Department of Revenue
Taxpayer Services Division
Sales Tax Section
P.O. Box 66362
Baton Rouge, LA 70896
PLEASE PRINT OR TYPE.
Legal Name
Louisiana Sales Tax Account Number
Trade Name
Mailing Address
City
State
ZIP
Manufacturing Facility Location Address
City
State
ZIP
Check one:
Manufacturer of tangible personal property for resale with a manufacturing establishment or facility within the state.
Private, nonprofit, tax-exempt organization as defined under Section 501(3)(c)of the Internal Revenue Code.
If a manufacturing facility, list the major types of goods manufactured:
Are these goods resold?
Yes
No
If no, please explain:
Year 20____
Year 20____
Year 20____
Total taxable purchases of tangible personal property
Total taxable leases or rentals of tangible personal property
Total taxable purchases of services
Total
(must average $5 million per year)
AUTHORIZATION
I affirm that the information given on this application is true and correct.
Authorized Representative
Title
Signature
Date
(mm/dd/yyyy)
X

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