West Feliciana Parish                                                                          SALES AND USE TAX REPORT
    Sales and Use Tax Collector
                   P O Box 1910
          St. Francisville, LA 70775
                                                                                                                         TAXPAYERS NUMBER
             Phone: (225) 635-4989

                                                                                                      Month of 
                                                                                                      Freq

1. Gross  sales of tangible personal property, leases, rentals and                                          State Tax ID 
services as reported to the State of Louisiana. (Before Taxes) 
                   ALLOWABLE   DEDUCTIONS                                                                   PLEASE INDICATE  ANY CHANGES BELOW
2. Sales for resale or further processing (Certificate of File).                                            DATE OUT OF BUSINESS  ___/____/___ 
3. Cash discounts, sales returns and allowances.                                                            DATE BUSINESS  SOLD ___/____/____
4. Sales delivered or shipped outside this jurisdiction (Does not include repairs)                          NAME OF NEW OWNER ____________________
5. Sales of gasoline and motor fuels.                                                                       Email _______________________________
6. Sales to U.S. Government, State of La , its political subdivisions and agencies.                                     TO AVOID PENALTIES BE SURE THAT YOU TRANSMIT 
7. Purchases paid with Food Stamps of WIC vouchers.                                                                     THIS RETURN ON OR BEFORE THE 20TH OF EACH 
                                                                                                                        MONTH FOLLOWING THE PERIOD COVERED.  ** 
8.                                                                                                                      WARNING: DO NOT USE ANY OTHER TAXPAYER'S 
9.                                                                                                                      RETURN AS THIS MAY RESULT IN THE IMPROPER 
10.                                                                                                                      POSTING OF YOUR PAYMENT
11. Total allowable deductions (Line 2 thru 10).
                                                                                                                        COMPLETE ONLY THOSE COLUMNS IN WHICH 
12. Adjusted  Gross  Sales (line 1 minus 11).                                                                                  TAXABLE ACTIVITY OCCURS
                                                                                                      COLUMN A                 COLUMN  B
                                                                                                      St. Francisville         West Feliciana Parish
    COMPUTATION OF SALES AND USE TAX                                                                  Inside Town Limits
                                                                                                      5.50 %                   5.0 %
13. Adjusted gross sales in each jurisdicition (Total of columns must equal line 12).
14. Purchases subject to use tax in each jurisdiction.
15. Total (line13 plus 14).
16. Tax Due (Multiply Line 15 by % shown in column).
17. Excess tax collected
18. Total (Line 16 plus 17)
19. Vendor's compensation   (1.1 % of line 18. Deductible only when payment is not delinquent). 
                                               
20. Net tax due (Line 18 minus Line 19).
21. Delinquency Penalty (5% of tax for each 30 days or faction thereof delinquency not to exceed 25% )
22. Interest ( 12% Annual Rate)
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 Line 24).

                                                                                                      Date               Total Remittance
                                                                                                      Phone              Check Number 
    Signature of Owner or Agent
                                                                                                                                                      10/28/2022