Form R-1345 - Seafood Processing Facility - Exemption Application - 2016

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R-1345 (12/16)

Mail To:

Louisiana Department of Revenue

Seafood Processing Facility

Revenue Processing Center

Exemption Application

P. O. Box 4998

La. R.S. 47:305.20

Baton Rouge, LA 70821-4998

Phone: (855) 307-3893

PLEASE PRINT OR TYPE.

Name

Louisiana Sales Tax Account Number

Trade Name

Mailing Address

City

State

ZIP

Location address (if different)

City

State

ZIP

I do hereby apply for a certificate of exemption from Louisiana state sales and use taxes under Louisiana Revised Statute 47:305.20

and make the following statements:

I own, lease, or have exclusive contracts with commercial fishing vessels that have been qualified by the Louisiana Department of

Revenue as being entitled to a sales tax exemption.

Please complete either A, B, or C.

My owned vessel is named _________________________________________, and has a registration/document number of

____________________________________. The Louisiana Department of Revenue Exemption Certificate Number issued

for this vessel is ____________________________________.

Note: A copy of the approved commercial fishermen exemption certificate must accompany this application.

My leased vessel is named _________________________________________, and has a registration/document number of

___________________________________. The Louisiana Department of Revenue Exemption Certificate Number issued for

this vessel is ____________________________________.

Note: A copy of the lease contract for any vessel listed must accompany this exemption application.

I have an exclusive contract with ________________________________________ to purchase all of the catch from

____________________________, the registration/document number of which is ____________________________, for the

period of _________________________________. The Louisiana Department of Revenue Exemption Certificate Number

issued for this vessel is __________________________________.

Note: A copy of the exclusive purchase contract for any vessel listed must accompany this exemption application.

Under penalty of perjury, I declare that I have examined this application for exemption and accompanying documents, and to

the best of my knowledge and belief it is true, correct, and complete.

Authorization

I understand that exemption from state sales taxes is valid only as long as I am a seafood processor who meets all of the requirements for the exemption.

I understand that the exemption certificate issued by the Louisiana Department of Revenue may not be transferred to any other seafood processor.

Name

Title

Signature

Date

(mm/dd/yyyy)

Questions about the completion of this application should be sent to Sales.Inquires@la.gov.