Form R-5328 - Gasoline Tax Refund Registration For Farmers Page 2

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Location of farm
Parish
Total number of acres cultivated
Is farm owned by applicant? _ Yes _ No
Is farm leased? _ Yes _ No
Other status:
List tractors and farm machinery in which refund gasoline will be used to operate or propel the equipment used
in tilling the soil and for production of crops. If space is insuffi cient, attach a schedule.
Kind of Machine
Make
Model
Equipment ID Number
Location of farm
Parish
Total number of acres cultivated
Is farm owned by applicant? _ Yes _ No
Is farm leased? _ Yes _ No
Other status:
List tractors and farm machinery in which refund gasoline will be used to operate or propel the equipment used
in tilling the soil and for production of crops. If space is insuffi cient, attach a schedule.
Kind of Machine
Make
Model
Equipment ID Number

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