Form R-1029 H/m - Hotel/motel Sales Tax Return - Louisiana Department Of Revenue

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R-1029 H/M (3/04)
If your name has
If your address has
If amended return,
If final return,
O
O
O
O
changed, mark circle.
changed, mark circle.
mark circle.
mark circle.
Account ID (10 digit BMF #)
Hotel/Motel Sales Tax Return
Name
Louisiana Department of Revenue
Address 1
P.O. Box 3138
Address 2
Baton Rouge, Louisiana 70821-3138
Address 3
(225) 219-7356
(225) 219-2114 (TDD)
FOR OFFICE USE ONLY.
Field flag
Filing
period
1
00
1 Gross room rental receipts
1
00
2
00
2
00
2 Less exempt rentals to federal, state, and local government agencies
3
00
3 Taxable room rental receipts (Subtract Line 2 from Line 1.)
4
00
4 Gross sales of tangible personal property
(Used, consumed, or stored for use or consumption, or purchased
5
00
5 Cost of tangible personal property
or imported to be sold in coin-operated vending machines)
6
00
6 Leases, rentals, and services of tangible personal property
7
0
00
7 Total (Add Lines 3 through 6.)
8 Less gross sales, leases, rentals (other than room rentals), and services to federal, state, and local government agencies
8
00
9 Amount taxable (Subtract Line 8 from Line 7.)
9
00
10 Tax due (Multiply amount on Line 9 by 4%.)
10
00
11 Excess tax collected
11
00
12 Total (Add Line 10 plus Line 11.)
0
12
00
13 Vendor’s compensation (1.1% of Line 12, if not delinquent)
13
00
14 Gross tax due (Subtract Line 13 from Line 12.)
14
00
00
15 Sales tax credit
Purchases
Louisiana tax paid on purchases for resale
15
00
16 Net tax due (Subtract Line 15 from Line 14. If Line 15 exceeds Line 14, enter amount here and on Line 20.)
16
00
(5% of tax for each 30 days or fraction thereof of
17 Delinquent penalty
17
00
delinquency, not to exceed 25% in the aggregate)
18 Interest (1.25% per month from due date until paid)
18
00
Do not
Make payment to:
19 Total tax, penalty, and interest (Total of Lines 16, 17, and 18)
PAY THIS AMOUNT.
0
19
send cash.
00
Department of Revenue.
20
00
20 Overpayment to be refunded
(Do not claim a credit for this overpayment on any other return.)
EFT Tax Code 04141
Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete. If the
return is prepared by a person other than the taxpayer, his declaration is based on all the information relating to the matters required to be reported in the return of which he has any knowledge.
Preparer ID
Date
Signature
Signature of preparer other than taxpayer
This return is due on or before the 20th day of the month following the taxable period covered and becomes delinquent on the first day thereafter.
Telephone Number
If the due date falls on a weekend or holiday, the return is due the next business day and becomes delinquent the first day thereafter.
Complete only if change in business status has occurred. Please print or type.
Date business sold
Name of purchaser
Date business discontinued
NOTE: If your business has been discontinued or sold, your registration certificate must be sent to the Department of Revenue with
this report. If business is sold, the new owner should complete a new application for a separate number.
4310

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