R-1056 (10/07)
Certifi cate of Sales/Use Tax Exemption/
Exclusion of Purchases by Political
Subdivisions of the State of Louisiana
Louisiana R.S. 47:301(8)(c)
PLEASE PRINT OR TYPE.
Political Subdivision
Louisiana Dept. of Revenue Registration No. (if applicable)
Address
City
State
ZIP
The above referenced entity does hereby certify that the entity is a public agency of the State of Louisiana with legal status
as one of the following:
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State agency, board or commission
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Municipal government or instrumentality thereof
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Public Charter School (R.S. 17:3971-4001)
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Hospital service district
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Public housing authority
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Parish government or instrumentality thereof
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Parish school board or public school
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Law enforcement district
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Waterworks district
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Parish and municipal libraries
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Other _________________________________________
Purchases of tangible personal property and taxable services, and/or leases and rentals of tangible personal property
by the above referenced political subdivision are totally exempted from the sales tax levied by the State as provided by
R.S. 47:301(8)(c). The Louisiana Constitution, Article VI, §44(2) defi nes a political subdivision as “a parish, municipality, and
any other unit of local government, including a school board and a special district, authorized by law to perform governmen-
tal functions”.
The authorized person for the political subdivision certifi es that the entity meets the criteria for the sales tax exclusion under
R.S. 47:301(8)(c), and if sales tax is later found to be due, the entity will be responsible for any tax liabilities.
Signature of Authorized Agent
Authorized Agent
Title
Signature
Date (mm/dd/yyyy)
X