Form R-1314 - Application For Sales Tax Exemption For Sickle Cell Disease Organizations

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R-1314 (6/06)
Application for Sales Tax Exemption
for Sickle Cell Disease Organizations
Taxpayer Services Division
P.O. Box 201
Baton Rouge, LA 70821-0201
(225) 219-7356
(225) 219-2065 (Fax)
Please Print or Type
1. Nonprofit Organization Name
2. Home Address
City
State
ZIP
3. Mailing Address
City
State
ZIP
4. Telephone Number
The above organization hereby applies for the sales tax exemption allowed by Revised Statute 47:305.53. The exemption
covers sales at retail, rentals or leases, use, consumption, distribution, or the storage for use or consumption of tangible
personal property, or any taxable service. In applying for the sales tax exemption, the organization certifies the following:
1.The nonprofit organization was established prior to 1975; and
2.The organization conducts a comprehensive program on sickle cell disease that includes free education, free testing, free
counseling, and free prescriptions, transportation, and food packages for sickle cell patients.
5. Name and title of officer entitled to make purchases on behalf of the organization.
Name
Title
6. Officer of the organization completing the application.
Print/Type Name
Title
Signature
Date
For Official Use
Approved
Disapproved
Signature of Department Representative
Date

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