R-1377 (7/08)
                                Direct Payment Sales Tax Application
                                               R.S. 47:303.1
                              Mail completed application to:
                              Louisiana Department of Revenue
                              Taxpayer Services Division
                              Sales Tax Section
                              P.O. Box 66362
                              Baton Rouge, LA  70896
                                                                                                               PLEASE PRINT OR TYPE.
Legal Name                                                                     Louisiana Sales Tax Account Number

Trade Name

Mailing Address

City                                                                           State ZIP

Manufacturing Facility Location Address

City                                                                           State ZIP

Check one:
■   Manufacturer of tangible personal property for resale with a manufacturing establishment or facility within the state.
■   Private, nonprofit, tax-exempt organization as defined under Section 501(3)(c)of the Internal Revenue Code.

If a manufacturing facility, list the major types of goods manufactured:

Are these goods resold? ■Yes  ■ No      If no, please explain:

                                                              Year 20____      Year 20____                     Year 20____

Total taxable purchases of tangible personal property

Total taxable leases or rentals  of tangible personal property

Total taxable purchases of services

Total (must average $5 million per year)

                                                        AUTHORIZATION
I affirm that the information given on this application is true and correct.
Authorized Representative                                     Title

Signature                                                     Date (mm/dd/yyyy)
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