Form R-1028 - Blanket Exemption Certificate For Purchases By Registered Wholesalers For Resale Or Further Processing Under The Louisiana General Sales Tax Act

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R-1028 (3/98)
State of Louisiana
LGST-9
Department of Revenue
Blanket Exemption Certificate
for purchases by registered wholesalers for
resale or further processing under the Louisiana General Sales Tax Act
Date _______________________
This certifies that the following types of materials, goods, merchandise, and services purchased by the undersigned from ________________
___________________________________________________________ are to be used for resale or further processing for resale as tangible
personal property by the undersigned registered wholesale dealer and are, therefore, exempt from the advance tax provisions of Louisiana
Revised Statute 47:306B.
Registration certificate number (valid only if it includes the letter “W”)
Type of property to be resold
The undersigned purchaser further certifies that the location of the business shown below has been assigned a wholesale sales tax registration
number by the Department of Revenue, enabling him to make purchases of property for resale or further processing without payment to vendors
of the advance sales tax, and that his current account number is indicated above. The purchaser assumes full liability if the sale is later held
subject to tax, even though the seller has received this completed certificate.
Name of purchaser
Address
City, State, ZIP
Signature of purchaser’s authorized agent
Any purchaser who fraudulently signs this certificate without intent to use the property or services purchased as stated above will be subject to all
penalties provided for by Louisiana statutes. This certificate will remain in effect until withdrawn by the purchaser, or the purchaser’s sales tax
account is closed, or the purchaser’s ability to make tax-free purchases is amended or revoked by the Department of Revenue.

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