R -1312 (10/09)
Purchases or Sales of Specialty
Items by Carnival Organizations
Application/Exemption Certificate
Louisiana Revised Statute 47:301(13)(l)
Louisiana Revised Statute 47:305.40
Mail completed applications to:
Louisiana Department of Revenue
Special Programs Division
P.O. Box 66362
Baton Rouge, LA 70896-6362
Telephone: (225) 219-7356 • (TDD): (225) 219-2114
The organization hereby applies for exemption from the collection of state and local sales tax on sales of Mardi Gras
specialty items to its members as granted under the provisions of Louisiana R.S. 47:301(13)(l) and 47:305.40. The
organization also applies for exemption from sales and use tax on the purchases of specialty items for use in connection
with Mardi Gras activities. The organization certifies that it is a bona fide nonprofit organization domiciled in Louisiana,
and that the organization will participate in a parade during the next Mardi Gras season that it will sponsor or that will be
sponsored by another bona fide nonprofit carnival organization.
The exemption is limited to specialty items that are specifically designed for the carnival or nonprofit organization and bear the
carnival or nonprofit organization’s name or insignia, including but not limited to doubloons, necklaces, cups, and coasters.
PLEASE PRINT OR TYPE.
Organization Name
Home Address
City
State
ZIP
Mailing Address
City
State
ZIP
List the event or events at which members will use the Mardi Gras specialty items sold by this organization.
List the type of “specialty items” to be sold by the organization.
Name and title of officer entitled to make purchases on behalf of the organization.
Name
Title
Officer of the organization completing the application.
Name
Title
Signature
Date
(mm/dd/yyyy)
X
FOR OFFICIAL USE
■
Approved for the
Mardi Gras Season. Exemption expires
,20
_____________________________
_________________________
_________
■
Disapproved
Signature of Department Representative
Date
(mm/dd/yyyy)
X