Form R-1312-L - Application For Mardi Gras Specialty Items Exemption
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1R-1312-L (7/98)
State of Louisiana
Department of Revenue
Application for Mardi Gras Specialty Items Exemption
Please print or type.
1. Organization name ______________________________________________________________________________
2. Domicile address ____________________________
3. Mailing address ________________________________
__________________________________________
_______________________________________________
__________________________________________
_______________________________________________
City, State, ZIP
City, State, ZIP
4. Daytime telephone number _______________________________________________________________________
5. Type of organization:
carnival organization sponsoring a parade or ball during the ______ Mardi Gras season, or
nonprofit organization participating in a parade sponsored by a carnival organization during the ______ Mardi Gras
season.
6. List the event(s) for which qualifying purchases (subject to exemption suspension) will be made.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7. Explain the types of qualifying specialty items (subject to exemption suspension) to be purchased under the authority of
the exemption certificate.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8. Name and title of officer authorized to make purchases on behalf of the organization.
Print/Type Name
Title
9. Officer of the organization completing this application:
Print/Type Name
Title
Signature
Date
For official use:
Approved
Denied
Department of Revenue Representative
Date
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Parent category: Financial