Form R-5404 - Schedule F - Supplier/permissive Supplier - Schedule For Tax Bad Debt Credit/repayment Page 2

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R-5404(I) (7/06)
Schedule F
Supplier/Permissive Supplier – Schedule for Tax Bad Debt Credit/Repayment
Instructions
This form is to be completed when claiming credit for tax accrued and remitted to the state but not received from a
licensed distributor or licensed importer in accordance with Louisiana Revised Statute 47:818.22. Credit is limited to the
fuel tax only. To be eligible to receive this credit, the supplier or permissive supplier must have notified the Louisiana
Department of Revenue within 30 days of the failure of the licensed distributor or licensed importer to remit the tax in a
timely manner.
Complete all information at the top of the schedule including name, mailing address, telephone and fax numbers,
Louisiana Revenue account number and the month/year of report. This report must be filed with the supplier or permis-
sive supplier’s first monthly report following the notification.
Complete all columns listing the date of the purchase, the name of the defaulting licensee, and the details for each
transaction for which payment has not been received and for which notification was given to the Department. Credit is
limited to the amount of tax due from the licensed distributor or licensed importer.
In the event credit was given for an amount that was later remitted to the supplier or permissive supplier by the licensee,
report the amount of credit the supplier or permissive supplier must repay to the state in Column 8. The period in which
the credit was originally claimed must be indicated in Column 9.

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