Form R-1061 - Application For Direct Payment Of Lease/rental Tax To The Louisiana Department Of Revenue

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R-1061 (11/08)
Application for Direct Payment of Lease/Rental Tax to the
Louisiana Department of Revenue
(In accordance with Regulation La. R.S. 47:301(4)(d)(ii) and
LAC 61:I.4303.B.2.d)
Submit application to:
Louisiana Department of Revenue
Taxpayer Services Division
PO Box 66362
Baton Rouge, LA 70896
General Information
This application form is to be completed and submitted to the Louisiana Department of Revenue, Taxpayer Services, at the address shown
above. If approved, the applicant will be provided with a validated exemption certificate, with name and account number pre-entered. The
exemption certificate may then be reproduced as necessary for claiming exemption when leasing/renting property for use in the offshore
area outside Louisiana boundaries, in other states or countries, or in bona fide interstate commerce within and without Louisiana.
PLEASE PRINT OR TYPE.
Taxpayer’s Name
Louisiana Sales Tax Registration Number
Trade Name
Location Address
City
State
ZIP
Mailing Address
City
State
ZIP
Telephone
Fax
General Description of Business
Description of activity that involves the use of leased/rented property in:
1.
the offshore area, beyond Louisiana borders, or
■
2.
■
wholly or partly outside the State of Louisiana, or
3.
in bona fide interstate commerce, whereby the leased/rented property will be used to transport persons or property for hire
■
between states during more than 10 percent of its operational time or mileage while in the lessee’s possession.
4.
■
Other ______________________________________________________________________________________________
Authorized Taxpayer Representative
Title
Signature
Date
(mm/dd/yyyy)
X

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