Form R-3400 - Certification Of Donation Or Contribution Of Property Of A Sophisticated And Technological Nature
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3State of Louisiana
R-3400 (3/98)
Department of Revenue
P. O. Box 201, Baton Rouge, LA 70821-0201
Certification of Donation or Contribution of
Property of a Sophisticated and Technological Nature
Donor
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Educational
__________________________________________________________________________________
institution
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Description
__________________________________________________________________________________
of donation or
contribution
__________________________________________________________________________________
Value of the donation or contribution $ ______________
If new property, attach invoice. If used property, appraisal must be obtained from the institution accepting the donation.
Date the donation or contribution was accepted __________________________________________________________
I certify that the value shown is the correct appraisal value of the property described above.
_____________________________
Authorized signature, institution accepting the donation
Date
The donation or contribution described above was approved and accepted by the board of jurisdiction charged with the
supervision and management of the educational institution shown above. This property shall be used only for the purposes
of research, research training, or direct education of students as specified in La. Revised Statutes 47:37 and 47:287.755.
_____________________________
Authorized signature for the Board of Jurisdiction
Date
I certify that the property described above has been donated or contributed to the educational institution shown. The donor
shown above does not arbitrarily, capriciously, or unreasonably discriminate against any person because of race, religion,
ideas, beliefs, affiliations, age, sex, culture, physical condition, or political ideas or affiliations.
_____________________________
Authorized signature for the donor
Date
Department of Revenue copy
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