LAT 5A – TAX EXEMPT ANALYSIS                                                    20__   PERSONAL PROPERTY TAX FORM 
 RETURN TO:                                                         NAME/ADDRESS: (INDICATE ANY CHANGES) 
                                                                               
 CONFIDENTIAL   RS: 47:2327. Only the Assessor, the governing authority, and  Legal  Citation  &  Instructions:    This  report  shall  be  filed  with  the 
                Louisiana  Tax  Commission  shall  use  this  form  filled  out  by  Assessor of the parish indicated by April 1 stor within forty-five days 
                the  taxpayer  solely  for  the  purpose  of  administering  this  after receipt, whichever is later, in accordance with RS 47:2324. 
                statute. 
                                                                                                 ASSESSMENT 
 PROPERTY LOCATION:                                                              WARD:           NUMBER:                         
 (E911/PHYSICAL ADDRESS) 
 NAME OF BUSINESS:                                                               TYPE OF BUSINESS:            
 OWNER OR CONTACT:                                                               PHONE:            
                                                                                 EMAIL ADDRESS:              
 IMPORTANT!    USE      ATTACHMENTS IF NECESSARY 
               ATTACH THIS FORM TO FORM LAT 5 
                         SHADED AREAS FOR ASSESSOR’S USE ONLY – USE ATTACHMENTS IF NECESSARY 
 SECTION 1 – BUILDINGS 
  YEAR OF                CONTRACT NUMBER           ACQUISTION COST                   AMOUNT OF EXEMPTION                 DIFFERENCE SUBJECT 
  ACQUISITION            EXEMPTION                                                                                                    TO TAX 
                                                                                                                                                         
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 SECTION 2 – MACHINERY AND EQUIPMENT (EXCLUDE LICENSED MOTOR VEHICLES) 
 (GROUP BY YEAR OF ACQUISITION) 
  YEAR OF    CONTRACT NUMBER  ACQUISTION                    DESCRIPTION                 YEAR OF ACQUISITION           DIFFERENCE SUBJECT 
  ACQ.       EXEMPTION          COST                                                  AMOUNT OF EXEMPTION                                              TO TAX 
                                                                                                                                                                        
 SECTION 3 – FURNITURE AND FIXTURES 
 (GROUP BY YEAR OF ACQUISITION) 
  YEAR OF    CONTRACT NUMBER  ACQUISTION                    DESCRIPTION                 YEAR OF ACQUISITION           DIFFERENCE SUBJECT 
  ACQ.       EXEMPTION          COST                                                    AMOUNT OF EXEMPTION                                            TO TAX 
                                                                                                                                                                        
 SECTION 4 – CONSIGNED GOODS, LEASED, LOANED, OR RENTED EQUIPMENT, FURNITURE, ETC. 
             NAME AND ADDRESS                     PROPERTY DESCRIPTION             AGE   MONTHLY   PRESENT DAY           FAIR MARKET VALUE 
                                                                                         RENTAL    SELLING PRICE 
                                                                                                                       
                                                                                        TOTAL FAIR MARKET VALUE:       
                                                                                                ASSESSED VALUE:        
 NOTE:       PENALTIES  FOR  FAILURE  TO  FILE  THIS  FORM  INCLUDE  WAIVER  OF   NEED ASSISTANCE?  AFTER YOU REVIEW THE ENCLOSED TAX FORM 
             RIGHTS  TO  APPEAL  YOUR  ASSESSMENT  AND  MAY  INCLUDE  A  AND  YOU  FEEL  YOU  NEED  ASSISTANCE  PLEASE  CALL  YOUR 
             MONETARY PENALTY (RS 47:1992 & 2330)                                 ASSESSOR LISTED ABOVE AT           .  THANK YOU 
                                                           SIGNATURE AND VERIFICATION 
 “I declare under the penalties for filing false reports (R.S. 14:125; up to 500.00 fine or imprisonment for one year or both, plus additional penalties defined in Act 2330B of the 
 1989 Regular Session) that this return has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.”   
                                                             
 SIGNATURE OF TAXPAYER                            DATE      SIGNATURE OF PREPARER                                    DATE 
                                                             
 PRINTED/TYPED NAME OF TAXPAYER                             PRINTED/TYPED NAME OF PREPARER 
 
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