Form R-1048 - Annual Application For Exemption From Collection Of Louisiana Sales Taxes At Certain Fund-Raising Activities - 2016

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R-1048 (1/16)
Annual Application for Exemption from Collection of Louisiana Sales Taxes
at Certain Fund-Raising Activities
La RS 47:305.14
Application covers the period from date of approval through December 2016.
This form is for use by any nonprofit domestic, civic, educational, historical, charitable, fraternal, or religious organization when applying for exemption
from the collection of state sales tax on parking fees, admissions to, or sales by the organization at fund-raising events. Approval of the application does
not authorize the nonprofit organization to be exempted from taxes required by law to be paid on the organization’s purchases.
Answers to the questions below should be as full and complete as possible. Incomplete answers will cause the processing to be delayed or the exemption
to be denied. Applications should be submitted as far in advance as possible, but no later than thirty days prior to the event. If this is a supplemental
request adding or changing the fund-raising event(s), please include a copy of the original request.
Return the completed form to: Louisiana Department of Revenue, PO Box 3278, Baton Rouge, LA 70821-3278. If you have questions about the
completion of this form, please call (855) 307-3893 or email sales.inquiries@la.gov. Completed forms may be faxed to (225) 952-2541.
Name of Nonprofit Organization
Represented by
Daytime Telephone Number
Address
City
State
ZIP
Purpose of Organization
Does this organization endorse candidates for political office or is it otherwise involved in political activities?
Yes
No
If “Yes” explain:
How many fund-raising events will be held? ________ If more than one fund-raising event, please attach supplemental sheet provided to list information.
Description of Event
Location of Event
City
State
ZIP
Dates of Event
How will the proceeds, after the payment of direct necessary expenses, be used? If the proceeds are to be donated to a nonprofit organization, explain
how the organization will use the funds.
Will the event potentially yield a profit to any promoter, individual, or business which has contracted to provide services or equipment for the event(s)?
Yes
No
If “Yes” explain:
Does any profit-seeking business enterprise, operating in the trade area where this event will be held, sell products or services that are identical or similar
to the products or services that will be sold by this organization during the fund-raising event(s)?
Yes
No
If “Yes” explain:
I hereby certify that the above-named organization is a bona fide domestic, civic, educational, historical, charitable, fraternal, or religious organization; that the organization
is the actual sponsor of the event described; and that all the proceeds from the event, after necessary direct expenses, will be used to further the organization’s own purpose
or for the educational, charitable, religious, or historical restoration purpose stated above. The answers to the above questions are correct and complete, to the best of my
knowledge and belief. I also understand that any organization that fraudulently seeks exemption under R.S. 47:305.14 shall be subject to the civil and criminal penalties
provided for in the statutes.
Signature
Name
(Please Print)
Date
(mm/dd/yyyy)
OFFICE USE ONLY
Approved
Disapproved
Date
________________________ Applies only to this event.
(mm/dd/yyyy)
LDR Representative Signature ____________________________________________

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