Form R-5329 - Gasoline Tax Refund Registration For Operators Of Aircraft

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R-5329 (07/07)
Gasoline Tax Refund Registration
for Operators of Aircraft
• Complete and submit this application before
Louisiana Department of Revenue
purchasing refund gasoline.
Taxpayer Services Division/Excise Taxes Section
P. O. Box 201
Baton Rouge, LA 70821-0201
(225) 219-7656
(225) 219-2114 (TDD)
Please Print or Type
Name of Applicant
Date (MM,DD,YYYY)
Physical Address
Mailing Address
City
State
Zip
LA Account ID
FEIN/SSN
Home Telephone Number
Offi ce Telephone Number
Fax Number
Parish of Residence
Plane Storage/Hangar Location
List planes to be operated
Type of plane
Make
N-Number
Horsepower
A.F.C.* per hour
(If space is insufficient, attach schedule)
Signature of applicant
X
Furnish signatures of any other persons authorized to sign refund invoices for the above applicant when fuel is purchased.
Signature
Signature
X
X
FOR OFFICE USE ONLY
Region
Verifi ed By
Date (MM,DD,YYYY)
* A.F.C.- Average Fuel Consumption

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