R-1079 (3/19)

                                          Purchases for Resale by Foreign Purchaser
                                           Sales Tax Exemption Certificate
                                           Louisiana Revised Statute 47:301(10)(a)(i)

                                                                                                                  PLEASE PRINT OR TYPE
                                                 Purchaser Information
Legal Name

Business Name

Mailing Address

City                                                                        State/Province/Region ZIP/Postal Code Country

Location Address

City                                                                        State/Province/Region ZIP/Postal Code Country

Please provide the following information:
Domicile State/Province/Region                                         Domicile Country           Domicile Tax Account Number

Domicile License Number                   Please check appropriate box:
                                           Retail license number        Wholesale license number   Manufacturer’s license number

This certifies that all tangible personal property bought by the above-named purchaser is to be transported beyond the territorial limits 
of the State of Louisiana to be resold or further processed into new articles for sale at retail. Purchases for resale or further processing 
are exempt from state sales tax under the provisions of Louisiana Revised Statute 47:301(10)(a)(i). The purchaser hereby agrees that 
should this sale later be held subject to state sales tax, the purchaser assumes full liability for such tax.  

                                                 Seller Information
Seller Name

Location Address

City                                                                                              State        Zip

Notice to Seller: This certificate should not be accepted by the seller unless proof of registration or license number held by the out-
of-state dealer is furnished to the Louisiana seller. If the dealer is located outside of the country, a statement with attestation must be 
attached. Also, report this sale on Form R-1029, Louisiana Sales Tax Return, Schedule A, Line 29, sales for resale.

                                                 Authorization
Under penalties of perjury, I declare that I have examined this exemption certificate and accompany documents, and to the best of my knowledge and 
belief, it is true, correct and complete. 
Authorized Purchaser (please print)                                    Date (mm/dd/yyyy)

Signature                                                              Purchaser Title