Form R-1079 - Purchases For Resale By Foreign Purchaser
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1R-1079 (11/16)
Louisiana Department of Revenue
P.O. Box 201
Purchases for Resale by Foreign Purchaser
Baton Rouge, LA 70821-0201
Louisiana R.S. 47:301(10)(a)(i)
Telephone: (855) 307-3892
PLEASE PRINT OR TYPE.
Purchaser Information
Legal Name
Business Name
Mailing Address
City
State
ZIP
Location Address
City
State
ZIP
Please provide the following information:
Domicile State
Domicile Tax Account Number
Domicile License Number
Please check appropriate box:
■
Retail license number
■
Wholesale license number
■
Manufacturer’s license number
This certifies that all tangible personal property bought by the above-named purchaser is to be transported beyond the territorial limits
of the State of Louisiana to be resold or further processed into new articles for sale at retail. Purchases for resale or further processing
are exempt from state sales tax under the provisions of Louisiana Revised Statute 47:301(10)(a)(i). The purchaser hereby agrees that
should this sale later be held subject to state sales tax, the purchaser assumes full liability for such tax.
Authorization
Under penalties of perjury, I declare that I have examined this exemption certificate and to the best of my knowledge and belief, it is
true, correct and complete.
Authorized Purchaser
(please print)
Date
(mm/dd/yyyy)
Signature
Purchaser Title
Seller Information
Seller Name
Location address
City
State
Zip
Applicable State Sales Tax Rates
From
To
Rate
4/1/16
6/30/16
0%
7/1/16
6/30/18
0%
7/1/18
3/31/19
0%
Notice to Seller: Report this sale on Schedule A, Line 29, sales for resale.
CAUTION: Misuse of this exemption certificate will subject the purchaser or seller to payment of the tax and
all civil or criminal penalties provided for by Title 47 of the Louisiana Revised Statutes.
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