Form R-1057 - Application For Certification As A Political Subdivision For Sales/use Tax Exclusion
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1R-1057 (11/07)
application for Certification as a Political
subdivision for sales/use tax exclusion
Please mail completed application and copy of applicable law to :
Louisiana Department of Revenue
Taxpayer Services Division
P.O. Box 66362
Baton Rouge, LA 70896-6362
Please Print or tyPe.
Political Subdivision
Louisiana Department 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:
State agency, board or commission
■
Municipal government or instrumentality thereof
■
Public Charter School (R.S. 17:3971-4001)
■
Hospital service district
■
Public housing authority
■
Parish government or instrumentality thereof
■
Parish school board or public school
■
Law enforcement district
■
Waterworks district
■
Parish and municipal libraries
■
Other _________________________________________
■
Purchases of tangible personal property and taxable services, and/or leases and rentals of tangible personal property by the above ref-
erenced 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) defines 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 governmental functions” .
The authorized person for the political subdivision certifies 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.
a copy of the state law or local ordinance creating the political subdivision must be attached for review by the louisiana Department
of revenue.
signature of authorized agent
Authorized Agent
Title
Signature
Date (mm/dd/yyyy)
X
For official use
Louisiana Exemption Identification Number
■
■
Approved
Disapproved
Signature of Department Representative
Date (mm/dd/yyyy)
X
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