R-1029 (8/20) 
                               Louisiana Department of Revenue
                               Sales Tax Return
                               Location address:
                                                   Address
          Field flag
                               City                               State         ZIP

                                                                                                       Account Number
                                                                                                       Name(1)
                                                                                                       Name(2)
                                                                                                       Address(1)
                                    Do not use this form 
          FOR OFFICE USE ONLY.      for filing periods prior                                           Address(2)
                                    to August 2020.
                               Filing period                     mm/yy                                 City                                            State              ZIP

                                    U.S. NAICS                                                                                                         Please use blue or black ink.
                                    Code                                                                                                               Round to the nearest dollar. Do not use dashes.

                                 1 Gross sales of tangible personal property  ..................................................... 1
                                 2 Cost of tangible personal property     
                               (Used, consumed, or stored for use or consumption in Louisiana.) ................................. 2
                                 3 Leases, rentals, and services (Do not include motor vehicle leases  
                               or rentals, which must be filed electronically. See instructions.)  ..................................... 3

                                 4 Total (Add Lines 1 through 3.)  ................................................................................. 4
                                 5 Total allowable deductions (From Line 34, Schedule A. Do not include as a   
                               deduction any item not reported on Lines 1 through 3.)  ................................................ 5

                                 6 Amount taxable (Subtract Line 5 from Line 4.)  ....................................................... 6

                                 7 Tax due (Multiply amount on Line 6 by 4.45%.)  ......................................................... 7

                                 8 Excess tax collected (Do not include local sales tax.) ............................................. 8

                                 9 Total (Add Line 7 and Line 8.)  ................................................................................. 9
                                10 Vendor’s compensation (0.944%  of Line 9 if not delinquent. Limited to $1500.   
                               See instructions for additional information.) ................................................................ 10

                                11 Gross tax due (Subtract Line 10 from Line 9.) ....................................................... 11

                                12 THIS LINE INTENTIONALLY LEFT BLANK .................................................... 12                          0 0 0 0 0 0 0 0 0

                                13 Net tax due (Same as Line 11.) .............................................................................. 13
                               13A Donation to The Louisiana Military Family Assistance Fund  
                               (Enter the amount from Line 35 from the back of the return.) ............................................13A

                                14 Penalty (See instructions.) ..................................................................................... 14

                                15 Interest (See instructions.) .................................................................................... 15
                                                                                                  Mark this box if  
                                16 Total payment due (Add Lines 13, 13A, 14, and 15.)             payment made 
                                 Make payment to: Louisiana Department of Revenue.                electronically.
                                                PAY THIS AMOUNT  (DO NOT SEND CASH.) u                            ...... 16 

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Each physical location must register to                                         Taxpayer’s FEIN                                                        Parent Company FEIN
obtain a separate Revenue Account ID.

                                                        Final               Enter date                                                                 If amended return, 
                                                                            business 
                                                        return         sold/terminated.                                                                mark this box.        4023

R-1029 (8/20)                                                                         Percent 
Allowable Deductions – Schedule A                             Total Sales             Exempt
 17 Intrastate telecommunication services                                             22.472%
    (Do not include prepaid telephone cards.)
 18 Interstate telecommunication services                                             44.944%

 19 Prepaid telephone cards                                                           22.472%

 20 Electricity and natural gas or energy for non-                                    55.056%
    residential use 

 21 Steam and bulk or utility water used for non-                                     55.056%
    residential purposes

 22 Boiler fuel for nonresidential use                                                55.056%
    (See instructions.)

 23 Sales/purchase/leases/rentals of manufactur-                                      100%
    ing machinery or equipment
 24 Sales to U. S. government and Louisiana                                           100%
    state and local government agencies 
 25 Sales of prescription drugs                                                       100%

 26 Sales of food for home consumption                                                100%

 27 Electricity, natural gas, and bulk water for                                      100%
    residential use
 28 Sales in interstate commerce                                                      100%

 29 Sales for resale                                                                  100%

 30 Cash discounts, sales returns and                                                 100%
    allowances
 31 Tangible personal property sold for lease or                                      100%
    rental (See instructions.)
 32 Sales of gasoline, diesel, and motor fuel                                         100%
    (Sales for resale must be reported on Line 29.)
 33 Total from SCHEDULE A-1                                                           100%
     (Transactions taxed at 0%.) 

 34 Add Lines 17 through 33; enter here and on Line 5.
                        35A Donation of Vendor’s Compensation                35B Donation in Addition to Tax Due
The Military Family 
Assistance Fund 
Worksheet
35 Total Donation (Add Lines 35A and 35B) Enter here and on Line 13A on front of return. ...................................................................... 35

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature                                                                                                                                                       Date (mm/dd/yyyy)

Print Name                                            Title                                                                                                     Telephone

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

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                                                      PTIN, FEIN, or LDR account                                For Office  
                                                              number of paid preparer                           Use Only.

                                        Louisiana Department of Revenue • Post Office Box 3138 • Baton Rouge, LA  70821-3138
                                 This return is due on or before the 20th day following the taxable period covered and becomes delinquent on                                     4024
                                 the first day thereafter. If the due date falls on a weekend or holiday, the return is due the next business day and 
                                 becomes delinquent the first day thereafter.

R-1029 (8/20)
             Enter your Louisiana Revenue Account Number:

             Schedule A-1: Transactions Subject To 0% Tax
Description     Sales Tax Exemption                                                         Total Sales
                Code

 1

 2

 3

 4

 5

 6

 7

 8

 9

 10

 11

 12

 13

 14

 15

 16

 17

 18

 19

 20

 21 Add Lines 1 - 20; enter here and on Line 33 of Schedule A, under the Total Sales column.

                                                                                                       4025
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