R-1345 (12/16)
                                                                                           Mail To:
                                  Seafood Processing Facility                              Louisiana Department of Revenue
                                                                                           Revenue Processing Center
                                  Exemption Application                                    P. O. Box 4998
                                                   La. R.S. 47:305.20                      Baton Rouge, LA  70821-4998
                                                                                           Phone:  (855) 307-3893

                                                                                                   PLEASE PRINT OR TYPE.
Name                                                                                       Louisiana Sales Tax Account Number

Trade Name

Mailing Address

City                                                                                               State     ZIP

Location address (if different)

City                                                                                               State     ZIP

I do hereby apply for a certificate of exemption from Louisiana state sales and use taxes under Louisiana Revised Statute 47:305.20 
and make the following statements:
I own, lease, or have exclusive contracts with commercial fishing vessels that have been qualified by the Louisiana Department of 
Revenue as being entitled to a sales tax exemption.
Please complete either A, B, or C.
          My owned vessel is named _________________________________________, and has a registration/document number of 
          ____________________________________. The Louisiana Department of Revenue Exemption Certificate Number issued 
A.        for this vessel is ____________________________________.

          Note: A copy of the approved commercial fishermen exemption certificate must accompany this application.

          My leased vessel is named _________________________________________, and has a registration/document number of 
          ___________________________________. The Louisiana Department of Revenue Exemption Certificate Number issued for 
B.        this vessel is ____________________________________.

          Note: A copy of the lease contract for any vessel listed must accompany this exemption application.

          I have an exclusive contract with ________________________________________ to purchase all of the catch from 
          ____________________________, the registration/document number of which is ____________________________, for the 
C.        period of _________________________________. The Louisiana Department of Revenue Exemption Certificate Number 
          issued for this vessel is __________________________________.

          Note: A copy of the exclusive purchase contract for any vessel listed must accompany this exemption application.

Under penalty of perjury, I declare that I have examined this application for exemption and accompanying documents, and to 
the best of my knowledge and belief it is true, correct, and complete.
                                                                     Authorization
I understand that exemption from state sales taxes is valid only as long as I am a seafood processor who meets all of the requirements for the exemption.
I understand that the exemption certificate issued by the Louisiana Department of Revenue may not be transferred to any other seafood processor.
Name                                                                 Title

Signature                                                            Date (mm/dd/yyyy)

Questions about the completion of this application should be sent to Sales.Inquires@la.gov.