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 shallstbe filed  with the 
                Louisiana Tax Commission shall use this form filled out by  Assessor of the parish indicated by April 1  or 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:        
 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 
                                                                                                                                                      
 LAT05A                                                       1 of 2                                                      REVISION DATE: 1/2/2013 
 

 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 Section) 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
 
 LAT05A                                               2 of 2                                          REVISION DATE: 1/2/2013