R-1070 (1/11)
Application for Certification as a
Manufacturer or Farmer
for the Purpose of the Sales/Use Tax Exclusion
for Manufacturing Machinery and Equipment
Louisiana R.S. 47:301(3)(i), 301(3)(k), 301(13)(k)(i) and 305.25(A)
Louisiana Department of Revenue
Special Programs Division
PO Box 4998
Baton Rouge, LA 70821-4998
Telephone: (225) 219-7462 • TDD: (225) 219-2114
Questions about the completion of this application should be sent to Sales.
Inquiries@LA.GOV
Please submit completed application to the Louisiana Department of Revenue, Special Programs Division at the address listed above. All
applications must be accompanied by the applicant’s Federal Income Tax return.
Part 1
Legal Name
Trade Name
Louisiana Plant Facility Address
City
State
ZIP
Mailing Address
City
State
ZIP
Contact Person
Telephone Number
Part 2
Louisiana Department of Revenue Account Numbers
(List the account numbers for which this business is registered)
*Sales:
*Businesses must have a Louisiana Sales Tax Account
Number prior to submission of this application. Online tax
Withholding:
registration is available at
Corporate Income / Franchise:
Part 3
Louisiana Workforce Commission Information
Is this business required to register with the Louisiana Workforce Commission?
(Agricultural employers that pay at least $20,000 in wages during a cal-
endar quarter or employ at least 10 employees that work some portion of 20 or more weeks per year must register with LWC.)
❏
❏
YES
NO
(If you answered no to this question, go directly to Part 4.)
IF YES:
Louisiana Workforce Commission Employer Account File Number:
(Contact the LWC at (225) 342-3160 for assistance.)
North American Industry Classification System (business activity code) Code issued by the LA Workforce Commission: ________________
(Use the North American Industry Classification System (NAICS) code issued to this location from the Multiple Worksite Report if this is a separate location.)
(If you answered yes to the question above, go directly to Part 5.)
Part 4
Businesses that are not required to register with the Louisiana Workforce Commission must provide the NAICS code listed on the most recently
filed federal income tax return and include a copy of the federal form that shows this number.
NAICS Code: ____________________________________________ Copy of form submitted: _________________________________________
New businesses that have not filed a federal income tax return prior to filing this application must submit a signed affidavit stating that the company
will be primarily engaged in a business activity classified within the North American Industry Classification System. For information on the issuance of North
American Industry Classification System codes, please contact the Louisiana Workforce Commission at (225) 342-3160.
Part 5
Description of Business:
(Attach additional sheet(s) if necessary.)
Finished goods produced:
Signature of Owner/Officer
Title
Date