REVISED 01/01/17 
  WEBSTER PARISH SALES AND USE TAX REPORT                                                                                            
   Webster Parish Sales & Use Tax Commission                                                                                             Account                                                          
          P.O. Box 357  ♦ Minden, LA 71058-0357                                                                                     Sales for Month of                                        
          Phone (318) 377-8948  ♦ Fax (318) 377-4089                                                                                               (or Last Month of Reporting Period) 
                    Website: www.webstersalestax.org                                                                                               
                 Email: wpstax@webstersalestax.org                                                                           LA. Sales Tax No.    ________________________                                                                        
                    Make all remittances payable to:                                                                                                                                                                    
                                     
1. Gross SalesEmail:of Tangiblewpstax@webstersalestax.orgPersonal Property and Services as Reported  to the State of Louisiana                              1.                                                                            
                                                       ALLOWABLE DEDUCTIONS                                                                                          
 2. Sales For Resale                                                                                                                                         
 3. Cash Discounts, Sales Returns & Allowances                                                                                                                                                                                                                                
 4. Sales Delivered or Shipped Outside of Webster Parish                                                                                                                                  
 5. Sales of Gasoline and Motor Fuels                                                                                                                        
 6. Sales to the U.S. Govt., the State of LA, or its Political Subdivisions and Agencies                                                                     
 7. Sales of Food Paid for with USDA Food Stamps or WIC Vouchers                                                                                             
                                        OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY) 
 8.                                                                                                                                                                                                                      REPORT IN EVEN DOLLAR AMOUNTS  
                                                                                                                                                                                                                         Round up any amount 50¢ and Over                  
 9.                                                                                                                                                                                                                      Drop any amount 49¢ and below 
 10.                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                          This return is DUE on the 1  daystof the month following 
 11. Total Allowable Deductions (Line 2 thru 10)                                                                                                            11.                                           the  period  covered  by  this  return  and  becomes             
 12. Adjusted Gross Sales (Line 1 minus line 11)                                                                                                            12.                                           DELINQUENT if not transmitted on or before the 20 thday.         
    COMPUTATION OF SALES                   TOTAL LOCAL RATE  
                                                                                            A - 3%          B - 3.5%            C - 5.5%     D - 4%        E - 5.5%        F - 5.5%       G - 5.5%                       H - 4%          I - 5%         J - 5.5%           K - 4% 
          AND USE TAX                      MUNICIPALITY TAX                                                                    Sibley      Cotton Valley  Minden          Springhill     Cullen                         Sarepta         Dixie Inn      Dixie Inn          Doyline 
     COMPLETE ONLY THOSE                   SCHOOL DISTRICT                                                   SCHOOL DIST. #6                             SCHOOL DIST. #6                                                                                 SCHOOL DIST. #6    
   COLUMNS IN WHICH TAXABLE                PARISH WIDE TAX                                 SCHOOL BD/PJ  SCHOOL BD/PJ         SCHOOL BD/PJ SCHOOL BD/PJ  SCHOOL BD/PJ    SCHOOL BD/PJ   SCHOOL BD/PJ                   SCHOOL BD/PJ    SCHOOL BD/PJ   SCHOOL BD/PJ        SCHOOL BD/PJ 
          ACTIVITY OCCURS                  PARISH WIDE TAX                                LAW ENF. DIST. LAW ENF. DIST.  LAW ENF. DIST.  LAW ENF. DIST.  LAW ENF. DIST.  LAW ENF. DIST. LAW ENF. DIST.                 LAW ENF. DIST.  LAW ENF. DIST. LAW ENF. DIST.      LAW ENF. DIST. 
13. Adjusted Gross Sales in Each Jurisdiction (Must equal line 12) 13.                                                                                                                                                                                                              
14. Purchases Subject to Use Tax in Each Jurisdiction                                                                                                                                                                                                                               
15. Total (Line 13 plus Line 14)                                                                                                                                                                                                                                                    
16. Multiply Line 15 by % Shown (Each Column)                                  16.                                                                                                                                                                                                  
16A. Minden Economic Development District 1,2,3 or 4                                         NOT APPLICABLE TO THESE COLUMNS                                                      NOT APPLICABLE TO THESE COLUMNS - SEE ADDITIONAL INSTRUCTIONS                                     
 Multiply Line 15 by 2% (Enter 0 if not in Economic District) 
16B. Add Lines 16 & 16A, enter total here                                                                                                                                                                                                                                           
17. Excess Tax Collected                                                                                                                                                                                                                                                            
18. Total (Line 16 plus Line 17) (Except Column E. Line 16B plus Line 17)                                                                                                                                                                                                           
19. Vendors Comp. (1.5% of Line 18)      (If not delinquent)                   19.                                                                                                                                                                                                  
20. Net Tax Due (Line 18 minus Line 19)                                                                                                                                                                                                                                             
21. Delinquent Penalty (5% per 30 days, max. 25%)                              21.                                                                                                                                                                                                  
22. Interest  1% Per Month From Due Date Until Paid                            22.                                                                                                                                                                                                  
23. Total Tax, Penalty and Interest Due                                                                                                                                                                                                                                             
24. Tax Debit or Credit (Authorized memo must be attached)                                                                                                                                                                                                                          
25. Total Amount Due (Line 23 plus or minus Line24)                            25.                                                                                                                                                                                                  
                                                                                                                                                                                                                                        TOTAL REMITTED                     
26. Remittance Attached             (total of columns A, B, C, D, E, F, G, H, I, J, K)                                          Have you used the proper column?                                                         Line 26                    
                                                                                                                                                                                                                                                                              
   I declare, under the penalties for filing false reports, that this return (including any accompanying schedule and statements) has been examined by me and, to the best of my knowledge and belief, is a true,                           
   correct and complete return.  If the return is prepared by a person other than the taxpayer, his declaration is based on all  the information relating to the matters required to be reported in the return of                       $                                  
                                                                                                                                                                                                                                                                           
   which he has any knowledge. 
   SIGNATURE OF                                                                                                                                                Please Indicate Any Changes Below:                                                                      
   INDIVIDUAL/AGENT ___________________    ___________________________________________ DATE _  _______________                                                                  Date out of business/sold:   
   Dishonored check                     WARNING       DO NOT use any other taxpayer’s return as this will result in improper credit                                             Name of New Owner:                                                                     
   charge $20.00                                      DO NOT ignore Delinquent notices – Negligence penalties may be imposed                                                    Address of New Owner: