Sales And Use Tax Registration Application Form Page 3

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Louisiana Association of Tax Administrators
Page 3 of 4
9.
If Corporation, LLC, LLP, or Partnership: name, title, social security #,
home address, and telephone # of officers, members, managers, or partners (?)
Name:
Title:
SSN:
Address:
City:
State:
Zip:
Phone Number:
Name:
Title:
SSN:
Address:
City:
State:
Zip:
Phone Number:
10.
Agent for service of process: name, physical address, and phone number (?)
11.
Dates (?)
A. First date sales will be made from this location:
(01/01/2010)
B. Date business first started operations:
(01/01/2010)
12.
Nature of Business (?)
Retail Sales
Repair Service
Retail Service
Wholesale
Manufacturing/Fabricating
Contractor
Other
Describe in detail your business: Type of sales, activity, or service you perform:
13.
Requested reporting frequency and filing status (?)
Monthly
Quarterly
Semi-Annually
Annual
Occasional/Irregular
This is only a request. Reporting frequency and filing status will be determined by the Administrator according to parish
policy. Businesses with a location within a parish will automatically be registered to file on a monthly basis.
Occasional/irregular filers are intended for those businesses (1) that do not have a location within the parish and do not
intend on doing business within the parish on a regular basis; and/or (2) business that perform services that are not
taxable.
14.
Anticipated Taxable Transactions (?)
Parish Wide
State Wide
Other
Yes, please mail paper returns to my mailing address.
No, please do not mail paper returns to my mailing address. I will electronically file my returns.
4/27/2012

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