Form R-1349 - Pollution Control Equipment Sales/use Tax Exemption/refund Application
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9R-1349 (2/13)
Page 1 of ___
Louisiana Department of Revenue
Pollution Control Equipment
Office Audit Division
Sales/Use Tax Exemption/Refund Application
P.O. Box 3863
Louisiana Revised Statute 47:301(10)(l)
Baton Rouge, LA 70821
Louisiana Department of Revenue (LDR)
Received by LDR ________ Received by ________
Louisiana Department of Environmental Quality (DEQ)
Received by DEQ ________ Received by ________
PART 1: To be completed by applicant
Facility Name:
LDR Sales Tax Account Number:
Refund Tax Periods:
Legal Name:
(mm/dd/yyyy to mm/dd/yyyy) ________________ to ________________
Physical Address of Facility
Mailing Address of Facility (if different from physical address)
Street Address:
Address:
City/State/Zip Code:
City/State/Zip Code:
Parish:
Parish:
Contact Person:
Contact Person:
Position:
Position:
Contact Email Address:
Contact Email Address:
Telephone Number:
Telephone Number:
Fax Number:
Fax Number:
Is this application for (choose one):
Pre-Purchase Exemption
Post-Purchase Refund
Name of Project:
_______________________________________________________________________________________
Estimate the pounds of emissions per year to be reduced and/or the efficiency of the purchased equipment.
Equipment Efficiency:
Projected reduction in pounds of TRI:
Projected reduction in pounds of criteria air emissions
Other (Explain):
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