R-1362 (7/19)
                                                                                                  Return completed form to:
                                            Natural Disaster Claim for Refund of State            Louisiana Department of Revenue
                                              Sales Taxes Paid                                    P.O. Box 91138
                                                                                                  Baton Rouge, LA 70821-9138

Must attach Form R-1362S, Calculation of State Sales Tax Refund Due and Form R-1362D, Schedule of Tangible Personal 
Property Destroyed by a Natural Disaster
Louisiana residents whose property was destroyed by a natural disaster in a parish that has been declared by the President of the 
United States to be eligible for federal assistance, may use this form to claim a refund of the state sales tax paid on the destroyed 
property, if the loss was not fully reimbursed by insurance or otherwise as authorized by Louisiana Revised Statute 47:315.1.

                                                                                                                  PLEASE PRINT OR TYPE
Claimant’s Name                                                     DOB  (mm/dd/yyyy)     Social Security Number

Spouse’s Name                                                       DOB  (mm/dd/yyyy)     Spouse’s Social Security Number

Mailing Address          ■    Check box to indicate address change  City                                State     ZIP

Resident of Louisiana Since (mm/yyyy)                               Telephone    (Daytime)

                                            Location and Description of Destruction
Street Address (including apartment number)                         City                                                  ZIP

Parish                                        Date of Disaster      (mm/dd/yyyy)          Name or Description of Disaster 

Primary Cause of Destruction:                                       Type of Home:
  ■ Flood        ■ Wind       ■ Other_________________________        ■ House         ■ Apartment/Condo         ■ Mobile Home

Area(s) of the home that received damage:                                                                         Total Number of Areas  
  ■ Kitchen        ■ Living Room            ■ Dining Room           ■ Bedroom(s) (how many rooms) ______          that Received Damage
  ■ Breakfast Area ■ Den                    ■ Garage/Carport        ■ Bathroom(s) (how many rooms) ______
  ■ Patio          ■ Outdoor Structure      ■ Other ______________ 
1 Total amount of unreimbursed property loss from Form R-1362S, Line 3, Total Column.                             $

2 Total amount of state sales tax requested to be refunded from Form R-1362S, Line 6, Total Column.               $

                   Print Preparer’s Name      Preparer’s Signature                        Date (mm/dd/yyyy)
                                                                                                                  Check    ■ if Self-employed
    PAID
PREPARER           Firm’s Name ➤                                                          Firm’s FEIN ➤
USE ONLY
                   Firm’s Address ➤                                                           Telephone ➤

                                                                                               PTIN, FEIN, or LDR Account Number 
                                                                                                                of Paid Preparer
                                                                    For Office 
                                                                    Use Only.
                                                                    Page 1 of 4

R-1362 (7/19)
                                                                                              Return completed form to:
                                          Natural Disaster Claim for Refund of State          Louisiana Department of Revenue
                                                         Sales Taxes Paid                     P.O. Box 91138
                                                                                              Baton Rouge, LA 70821-9138

Certified Statement of Natural Disaster Refund Claim
The aforesaid individual, being duly sworn, deposes and says that the following statement is true and correct, that he is entitled to the 
refund requested, and that he is not delinquent with the State of Louisiana in the payment of any state taxes.
The property described on the schedule was destroyed by a natural disaster in a “natural disaster area” so declared by the President 
of the United States. I hereby certify:
•  That the destroyed property was held for personal use at my residence, was not owned by a business, partnership, or 
corporation, and was not otherwise used by any person for commercial purposes;
•  That the property was movable, both at the time of its purchase and at the time of its destruction;
•  That I paid the Louisiana state sales/use tax on my purchase of the destroyed property in the amounts now requested to 
be refunded, and that the property was not acquired by gift, purchased outside the state, or otherwise without payment by 
me of the Louisiana sales/use tax; and,
•  That all expected and actual reimbursements from insurance and other sources have been included.

Natural disaster refund claims must be notarized to be processed. Filing or submitting false information or false representation 
on this refund claim may result in jail time of 5 years and/or fines up to $5,000 under Louisiana Revised Statute 14:133.

SWORN TO AND SUBSCRIBED BEFORE ME THIS ______________________________ day of ____________________,  __________
                                                                                                                            year

Claimant’s Name (please print)                                            Claimant’s Signature

Spouse’s Name   (please print)                                            Spouse’s Signature

Paid Preparer Name if other than taxpayer (please print) Signature of Paid Preparer           Paid Preparer Telephone Number

Notary Name (please print)                               Notary Signature                     Notary Number

                                                                          Page 2 of 4

) ) )

TOTAL

(Column A + B +C)
PLEASE PRINT OR TYPE $ ($ ($ ($ $ $
) ) )

4.45%
4.45% tax rate
R-1329D, Column C
$ ($ ($ ($ $ $
) ) )

Form R-1362

5%
5% tax rate
R-1329D, Column B
$ ($ ($ ($ $ $
Must be attached to Natural Disaster Claim for Refund of State Sales Taxes Paid – ) ) )

Social Security Number Spouse’s Social Security Number
4%
4% tax rate Page 3 of 4
R-1362D, Column A 
$ ($ ($ ($ $ $

Calculation of State Sales Tax Refund Due

Natural Disaster Claim for Refund 
actual or anticipated  Subtract Line 2C from Line 1 for 
Calculation of State Sales Tax Refund Due  Multiply Line 3 by the sales tax rates 

Add Lines 2a and 2b for Columns A, B, and C. 

 Check box if destroyed property was not covered by insurance.  Check box if you were denied reimbursement from an employer.  Check box if you were denied reimbursement from any disaster relief agencies, including FEMA.
      
Total cost of destroyed property from attached Form(s) R-1362D Reimbursement of destroyed property Reimbursement from insurance – ■ Reimbursement from employer or disaster relief agencies ■ ■ Total reimbursement – Total unreimbursed property loss – Columns A, B, and C. State sales tax rate State sales tax computation – found on Line 4 for Columns Total state sales tax refund requested. Add Line 5, Columns A, B, and C.  
Claimant’s Name Spouse’s Name 1 2 2a 2b 2c 3 4 5 6
R-1362S (7/19)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               COLUMN C                                                                                                          JULY 1, 2018
                                                                                                                                                                                                                                                                PLEASE PRINT OR TYPE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Original cost of Property                          Purchased ON or AFTER  

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               COLUMN B
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Original cost of Property                          Purchased BETWEEN  
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 APRIL 1, 2016 – June 30, 2018
                                                                                                                                                                                                     Form R-1362

                                                                    Must be attached to Natural                                    Disaster Claim for Refund of State                                Sales Taxes Paid –                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        COLUMN A                                                                                                          APRIL 1, 2016
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Original Cost of Property                          Purchased PRIOR TO  
                                                                                                                                                                                                                                                                                    Social Security Number                                Spouse’s Social Security Number

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             for examples of qualifying items.                                                                                                                                                                                                                                                                                                                                                 Page 4 of 4

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Date of                                                                            Purchase              (mm/dd/yyyy)

                                                                                                                                                                                                                                                                                                                                                                         our homeowner’s or renter’s insurance policy and a copy of the insurance adjuster’s report that documents the damage 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                insurance, attach all available purchase receipts for the destroyed items and any documentation of reimbursement from Federal                                                                                                                                 ster relief sources. Attach copies of any letter from insurance copy, FEMA, or other disaster relief agencies showing denial of                               Claim for Refund Instructions,

                                                                                                                                                                      Schedule of Tangible Personal  

                                                                                                                                                                                                                        Property Destroyed by a Natural Disaster
                                  NATURAL DISASTER CLAIM FOR REFUND                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Natural Disaster 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Destroyed

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Description of Property  
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       (Total columns A, B, and C.)

R-1362D (7/19)                                                                                                                                                                                                                                                                      Claimant’s Name                                       Spouse’s Name                  To support your claim, attach a copy of the declaration page of y                                                      and claim reimbursement amounts. If you did not have                                                                                                                                                                                                          Emergency Management Agency (FEMA) or other disa                                                                                                              reimbursement. Please see R-1362i,                                                                                                                                                                                     Total Property Cost                                                                     If more space is needed, additional copies of this form may be used.
xecutive Review 7.18.2019