Form R-1018 - Exemption Certificate

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R-1018 (12/08)
LGST-200-2
Purchases of manufactured homes, parts and acces-
sories for manufactured homes, and for the resale of
manufactured homes by manufactured homes retailers
Exemption Certificate
La. R.S. 47:301(16)(g)
PLEASE PRINT OR TYPE.
Purchaser
Address
City
State
Zip
This certifies that the purchaser listed above is a retailer in manufactured homes and has been issued License Number ______________
by the State Fire Marshal’s Office of the Louisiana Department of Public Safety.
All purchases from
Supplier Name
Address
City
State
ZIP
will be manufactured homes, or will be tangible personal property that will become component and integral parts of manufactured
homes held by the purchaser for resale, or will be an accessory that will be taxed as part of the manufactured home at the time of
registration and titling in Louisiana. The individual manufactured home on which the property will be installed, or to which the service will
be rendered, will be identified to the seller at the time of purchase, as required by the Louisiana Department of Revenue. I am claiming
exemption from the payment of state sales and use taxes on my purchases from you under Louisiana R.S. 47:301(16)(g) of the sales
tax law. I agree that if my purchases from you are later held subject to the sales or use tax, I assume full liability therefor. This certificate
will remain in effect until the scheduled expiration date of my current dealer retailer license on December 31, 20_________, unless the
license expires, is revoked, or the business closes operation sooner.
Name
Title
Signature
Date
(mm/dd/yyyy)
X
General Information
1.
This exemption form should be retained by the seller. The form expires December 31 of the calendar year in which it is issued.
2.
Manufactured homes on which parts and services are to be used must be identified to the seller by complete description of make,
year, model, and vehicle identification number, or by reference to the retailer’s stock number. The manufactured home identification
information must be recorded in the seller’s records.
3.
The retailer in manufactured homes must maintain complete records to show the individual manufactured homes on which the parts
were used, or to which services were rendered.

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