Form R-1010 - Blanket Certificate Of Exemption - 1995
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1R-1010 (1/95)
State of Louisiana
LGST-51B
Department of Revenue and Taxation
Blanket Certificate of Exemption
applying to ships and vessels operating solely in foreign or interstate coastwise
commerce under the Louisiana General Sales Tax Act (Revised Statute 47:305.1)
Date _________________________
This certifies that the
(1) material and supplies and/or
(2) laundry services and/or
(3) repair services
listed on the attached invoice or invoices were purchased by the undersigned owner of the ship or vessel.
______________________________________________________________________________________________________
(Name of vessel)
__________________________________________________________________________________________________ from
__________________________________________________________________________________________________
,
(Home port of vessel)
Name __________________________________________________________________________________________________
Address ________________________________________________________________________________________________
(City, state)
(ZIP)
are for use or consumption solely in the operation of said vessel in foreign or interstate coastwise commerce. It is further certified
that this ship or vessel is currently engaged exclusively in foreign or interstate coastwise commerce in the transportation of goods
or persons from points in one state to points in another state or from points in a state to points in a foreign nation or the offshore
area. The material, supplies, and laundry were loaded on said ship or vessel, and the repairs invoiced were performed upon said
ship or vessel.
Name _________________________________________ Signature ______________________________________________
Address _______________________________________________________________________________________________
Any intrastate activity in Louisiana or in any other state during the current voyage will invalidate the vessel's eligibility for this
exemption. Misuse of this certificate by either the seller or the purchaser will subject either party to all penalties provided by law.
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