R-1344 (7/18)

                Purchases of Tangible Personal Property for Rent or Lease, 
                                                           Other than Motor Vehicles
                                                           Sales Tax Exemption Certificate
                Louisiana Revised Statute 47:301(10)(a)(iii)

                                                                                                PLEASE PRINT OR TYPE
                Purchaser Information
Business Name                                                                             Louisiana Sales Tax Account No.

Mailing Address

City                                                                                      State ZIP

Location Address

City                                                                                      State ZIP

This certifies that the tangible personal property purchased by the above named purchaser is to be offered for rent or lease in an arm’s 
length transaction. This also certifies that the gross proceeds received from the rent or lease of the property will be subject to all applicable 
rental tax that must be remitted. It is understood that any use of the property for purposes other than rent or lease in an arm’s length 
transaction will subject the property to a sales/use tax liability on its cost of fair market value at the time of such use.

                Property Purchased for Rent or Lease

Notice to Dealer: Report this sale on Schedule A, Line 31. 

                Seller Information
Seller’s Name

Address

City                                                                                      State    ZIP

Under penalty of perjury, I declare that I have examined this exemption certificate and accompanying documents, and to the 
best of my knowledge and belief, it is true, correct, and complete.
                Signature of Authorized Agent
Name                                                       Title

Signature                                                  Date    (mm/dd/yyyy)

Questions about the completion of this form should be sent to Sales.Inquiries@la.gov.