LAT 5 – INVENTORY, MERCHANDISE, ETC.                                          20       PERSONAL PROPERTY TAX FORM 
 RETURN TO:                                                       NAME/ADDRESS: (INDICATE ANY CHANGES) 
                                                                             
 CONFIDENTIAL   RS:  47:2327.  Only  the  Assessor,  the  governing  Legal Citation & Instructions:  This report shall be filed with the Assessor 
                authority, and Louisiana Tax Commission shall use this  of the parish indicated by April 1  orstwithin forty-five days after receipt, 
                form filled out by the taxpayer solely for the purpose of  whichever is later, in accordance with RS 47:2324. 
                administering this statute. 
                                                                                                   ASSMT 
 PROPERTY LOCATION:                                                     WARD:                      NUMBER:                 
 (E911/PHYSICAL ADDRESS) 
 NAME OF BUSINESS:                                                      TYPE OF BUSINESS:            
 OWNER OR CONTACT:                                                      PHONE:            
 IMPORTANT!    AN ITEMIZED DEPRECIATION SCHEDULE, LISTING ASSETS (INCLUDING FULLY DEPRECIATED ITEMS AND/OR 
                EXPENSED ITEMS) SHALL ACCOMPANY THIS REPORT. 
               FIRMS HAVING 10 YEAR EXEMPTIONS SHALL COMPLETE FORM LAT 5A AND ATTACH TO THIS FORM. 
               BANKS ONLY:  ATTACH TO THIS REPORT A LIST OF SHAREHOLDERS AND A COPY OF YOUR CONSOLIDATED REPORT 
                OF CONDITION AND CONSOLIDATED REPORT OF INCOME AS FURNISHED TO THE OFFICE OF FINANACE INSTITUTIONS 
                OR TO THE COMPTROLLER OF CURRENCY AS OF DECEMBER, 31ST. 
                          SHADED AREAS FOR ASSESSOR’S USE ONLY – USE ATTACHMENTS IF NECESSARY 
 SECTION 1 – INVENTORIES AND MERCHANDISE 
 METHOD OF REPORTING: (CHECK ONE)      LIFO   FIFO       COST      RETAIL        OTHER:             
                MERCHANDISE           RAW MATERIALS     WORK IN PROGRESS        FINISHED GOODS              SUPPLIES                   TOTAL 
 JANUARY                                                                                                                                               
 FEBRUARY                                                                                                                                              
 MARCH                                                                                                                                                 
 APRIL                                                                                                                                                 
 MAY                                                                                                                                                   
 JUNE                                                                                                                                                  
 JULY                                                                                                                                                  
 AUGUST                                                                                                                                                
 SEPTEMBER                                                                                                                                             
 OCTOBER                                                                                                                                               
 NOVEMBER                                                                                                                                              
 DECEMBER                                                                                                                                              
                                                                                GRAND TOTAL: 
 ASSESSED VALUE:                                                                                                                                       
                                                                                      AVERAGE:                                                         
  
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 SECTION 2 – FURNITURE AND FIXTURES 
 (GROUP BY YEAR OF ACQUISITION) 
  YEAR OF     ACQUISTION COST    DESCRIPTION                                   YEAR OF   ACQUISTION COST             DESCRIPTION 
 ACQUISITION                                                  ACQUISITION 
                                                                                                                                 
                                                              15 Years or over.                                                  
                                                                                          TOTAL MARKET VALUE:                                           
                                                                                            ASSESSED VALUE:                                             
 SECTION 3 – MACHINERY AND EQUIPMENT (EXCLUDE LICENSED MOTOR VEHICLES) 
 (GROUP BY YEAR OF ACQUISITION) 
  YEAR OF     ACQUISTION COST    DESCRIPTION                                   YEAR OF   ACQUISTION COST             DESCRIPTION 
  ACQUISITION                                                 ACQUISITION 
                                                                                                                                 
                                                              25 Years or over.                                                  
                                                                                          TOTAL MARKET VALUE:                                           
                                                                                            ASSESSED VALUE:                                             
 SECTION 4 – LEASEHOLD IMPROVEMENTS/MISC. PROPERTY 
 (GROUP BY YEAR OF ACQUISITION) 
              ITEM                               YEAR OF     ACQUISTION COST                              DESCRIPTION 
                                 ACQUISITION 
                                                                                                                     
                                                                                         TOTAL FAIR MARKET VALUE:     
                                                                                            ASSESSED VALUE:           
 SECTION 5 – CONSIGNED GOODS, LEASED, LOANED, OR RENTED EQUIPMENT, FURNITURE, ETC. 
 (ATTACH LIST SHOWING NAME, ADDRESS, TYPE AND AGE OF PROPERTY, MONTHLY RENTAL) 
 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 
 
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