Allen Parish School Board 
                            Sales andthUse Tax 
                             1111 W 7  Avenue 
                             P.O. Drawer 190 
                             Oberlin, LA  70655 
                                                 
                           Application for Exemption Certificate 
 
Account Number:                                   
 
Account Name:                                             Telephone:                                           
 
Business Owner’s Name:                                    Owner’s Soc Sec:                                     
 
Mailing Address :                                                                                              
 
City:                                            State:               Zip:                                     
 
Nature of Business:                                                                                            
 
Purpose of request for Exemption Certificate:                                                                  
 
                            ACKNOWLEDGEMENT 
 
I,                                             , acting in an authorized capacity for                          
 
                            do  hereby  certify  that  the  information  contained  herein  is  true  and 
correct  to  the  best  of  my  knowledge  and  that  the  certificate  requested  will  be  used  solely  for  the 
purpose(s) specified in this application.  Use of the certificate for any purpose other than made known in 
this application shall subject applicant to full penalties under the laws of this state and local ordinances. 
 
                                               Signed:                                                         
                                                
                                               Date:                                                           
 
FOR OFFICE USE ONLY:                           Received:                                                       
 
Request:           Granted                       Denied    
 
If denied, give reason:                                                                                        
 
                                               Signed:                                                         
                                                          Sales & Use Tax Department 
 
                             REPRESENTING: 
 
Allen Parish School Board       Town of Kinder                                         Town of Oberlin 
Allen Parish Police Jury        Town of Elizabeth                                      City of Oakdale 
 
                            Equal Opportunity Employer