Form R-1130 - General Contractor/subcontractor/supplier List
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2R-1130 (11/08)
Job # __________________
General Contractor/Subcontractor/Supplier List
Louisiana Department of Revenue
Taxpayer Services Division
P.O. Box 4998
Baton Rouge, LA 70821-4998
(225) 219-7356, Option 3
General Contractor
Project Name
Name
Address
Address
City
State
ZIP
City
State
ZIP
Start date of project
Ending date of project
(mm/dd/yyyy)
(mm/dd/yyyy)
Amount of contract
$
Subcontractor Contractor
Subcontractor Contractor
Name
Name
Address
Address
City
State
ZIP
City
State
ZIP
Amount of contract
$
Amount of contract
$
Subcontractor Contractor
Subcontractor Contractor
Name
Name
Address
Address
City
State
ZIP
City
State
ZIP
Amount of contract
$
Amount of contract
$
Subcontractor Contractor
Subcontractor Contractor
Name
Name
Address
Address
City
State
ZIP
City
State
ZIP
Amount of contract
$
Amount of contract
$
Subcontractor Contractor
Subcontractor Contractor
Name
Name
Address
Address
City
State
ZIP
City
State
ZIP
Amount of contract
$
Amount of contract
$
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Parent category: Financial