Form R-1376 - Governmental Employees Hotel Lodging Sales/use Tax Exemption Certificate
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R-1376 (1/09)
Governmental Employees Hotel Lodging
Sales/Use Tax Exemption Certificate
Louisiana Revised Statute 47:301(8)(c)
This certificate is for use by employees of the United States government and the State of Louisiana and its political subdivisions. It is used
to document employee eligibility for exemption from payment of state sales taxes on hotel lodging charges that are directly reimbursable
by the government employer.
PLEASE PRINT OR TYPE.
Employee Name
Hotel Folio or Reference Number
Employee Title
Government Agency Employer
Agency’s Address
City
State
ZIP
Agency’s Telephone Number
This certifies that the employee named above is an employee of the above named government agency and that the lodging charges
incurred are necessitated by the employee’s conduct of the official business of this government agency. The employee’s lodging expenses
are required to be accounted for to his government agency employer and are reimbursable by the government agency to the employee in
the actual amount incurred. This government agency, therefore, claims exemption from the payment of state sales taxes on the lodging
charges for the occupancy of the employee’s hotel room.
Authorization
Employee Name
Employee Title
Employee Signature
Date
(mm/dd/yyyy)
X
Government Agency Representative
Government Agency Representative Title (other than employee)
(other than employee)
Government Agency Representative Signature
Date
(mm/dd/yyyy)
X
Hotel Information
Hotel’s Name
Seller’s Louisiana Sales Tax Registration Number (if applicable)
Dates of Employee’s Stay
(mm/dd/yyyy)
Note: This form is valid only for documenting eligibility for exemption from the payment of state sales tax on charges for room occupancy.
The state sales tax must be paid on other taxable purchases from the hotel, including meals, laundry, dry cleaning, and vehicle
parking. When this form bears the signature of only the employee, the form must be accompanied by a copy of the employee’s
written travel orders which states the dates and destination of the authorized travel. The hotel must retain this certificate and a
photocopy of the travel orders to document the exemption. This form is not valid to document exemption from the payment of local
room occupancy taxes.
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