FOR OFFICE USE ONLY    OCCUPATIONAL LICENSE APPLICATION MAIL ORIGINAL AND REMITTANCE TO:     
ACCOUNT NUMBER  ASCENSION PARISH SALES & USE TAX AUTHORITY        Post Office Box 1718   
 
COLLECTOR OCCUPATIONALOF LICENSE TAX FOR      
 Gonzales, LA 70707    
Gonzales, LA  225.621.2635 
PARISH OF ASCENSION   Fax 225.621.2644 
Donaldsonville, LA 225.473.8630  
1. Reason for applying:  
 A. Started new business   D. Purchased ongoing business: 
 B. Opening additional location     Name of previous   owner    
 C. Other ____________________________      Trade name of previous   business ______________________________ 
     Parish account number ______________________________________ 
2. A. Legal name (s): (  Individual, partners, or    corporation) _________________________________________________________________ 
  
B. Trade name of business:   __________________________________________________________________________________  
C. Business location address  (Street –Not   , City and State, Zip, Telephone:   P.O. Box)
_________________________________________________________________________________________________________ 
D. Address for receiving correspondence  (If same as location   write “Same”),   City and State, Zip:  
_________________________________________________________________________________________________________ 
3. Type    of organization:     A. Individual   B. Partnership   C. Corporation   D. LLC   E. LLP   F. Non Profit‐  
4. If sole owner (individual) Name: ______________________________________________SSN___________________________     
Home address___________________________________________________________ Telephone _______________________   
5. If Corporation, LLC, LLP, or Partnership,    attach a listing of all officers,   members,     managers, or partners. This list shall include   the      
following information: Name, title,  social security  #, home address,   and telephone #.     
6. First date sales will be made from this location:  ___________________ Date business  first started operations: ______________       
7. Describe   in detail your business  (type of   sales, activity, or service   you perform):  ________________________________________________ 
________________________________________________________________________________________________________ 
8. Class of   license being applied for  (Ex.: Hotel, Peddler, etc. See back of this page for   classes.):    _______________________________________ 
9. If your business will have any of the following:   Video Games, Flipper Machines, Electronic Pinball, or Pool Table, fill out an         
additional application for Amusement Machines License(s).  
 COMPLETE ONE OF THE FOLLOWING:  
   Business opened on or prior   to June   of30 current    year  Due$50  
   Business opened on or after   July 1 of current     year        Due$25   
(The above are Temporary License fees. A Permanent    License will be issued after being open 30 days and      
NEW will be based on those  gross receipts multiplied by the remaining   months in the calendar year.)      
 Flat Fee Business (Fireworks Stand, Peddler, or Special Event)          $100 Due  
 
 If business opened more than 30 days ago during current year:  
st
Enter gross receipts (1 days30  in business    for current year)        $_____________ 
  Less Allowed Deductions ( See  back.)   $___________ 
Adjusted Gross Receipts          $_____________ 
Multiply adj gross receipts by number   of months (___) remaining   in year amounts to taxable   sales of          $_____________ 
 If business opened during the previous calendar year:  
Enter gross receipts (prior year total)         $_____________ 
BUSINESS
  Less Allowed Deductions ( See  back.)   $___________ 
Adjusted Gross Receipts          $_____________ 
Divide adj gross receipts by number   of days in   operation   (___)—[daily     $_____________ sales figure]
Multiply daily sales by to365    annualized   tax basis of          $_____________ 
EXISTING  If business opened on or   prior to January   1 of previous     calendar year:  
Enter gross receipts (prior year total)         $_____________ 
 Less Allowed Deductions ( See  back.)   $___________ 
Taxable sales     of        $_____________ 

TAX DUE  (TABLE ____)    ALL RENEWAL APPLICATIONS ARE   LICENSE WILL BE ISSUED UPON ONLY RECEIPT OF COMPLETED APPLICATION          
DUE JANUARY 1 AND BECOME     Acknowledgement   of Other Regulatory Rules for Ascension Parish  
PENALTY   ( ___ %)    DELINQUENT MARCH 1 . LICENSES  ST  Completion of this   application and the payment  of the proposed   tax for issuance of an occupational   license   
NOT PAID THEBEFORE DELINQUENT    does not create any vested right to open   or operate   any business  in the Parish   of Ascension.    Applicant  
INTEREST  ___ ( %)     DATE BEAR INTEREST AND PENALTY   herein may be affected  by the   Ascension Parish subdivision  regulations, zoning laws, building codes, alcohol    
AS FOLLOWS:  or other types of   regulatory rules that may impact or prevent operation   of this particular   business.   
Applicant acknowledges that additional  permits or compliance   with other regulatory  rules may be required     
TOTAL DUE    to operate this particular business.  
A. PENALTY –        Please initial to   accept: FOR 5% EACH 30 DAYS
 OR FRACTION THEROF. MAX 25%.    
      CHECK #    B. INTEREST 1.25 FOR % EACH 30‐       This is     to affirm the statements  made herein are correct.  
  DAYS. 15% PER YEAR.    Signature of Owner   or Authorized   Agent  
REV. 07/12   X

Type                            Table         Type                               Table         Type                         Table              Type                            Table
Abstractor                      1             Debt Adjusters                     1             Merry Go Round               $20.00             Steam Cleaning                  1
Academy of Music                1             Decorator                          1             Messenger Service            1                  Steam Laundering                1
Accountants                     0.1% of Gross Delivery Service                   1             Miniature Golf                                  Steam Pressing                  1
Advertising Agency              1             Dentists                           0.1% of Gross Mobile Homes, Trlrs, Retail  1, Max $800.00     Stock & Bond Broker             4
Advisory Service                1             Detective Agency                   1             Modeling Agency              1                  Stock & Bond Dealer             4
Air Hockey Table                $20.00 each   Dispatcher                         1             Money Broker                 4                  Storage1
Air Transportation              1             Display Rooms                      $100.00       Monitor Service              1                  Surety Companies                1
Ambulance Service               1             Dist./Light, Heat or Power         5             Monogramming                 1                  Swim Club, Private              1
Amusement Device, Mech          $20/$50       Distiller of Alcohol               4             Mortgage Broker              4                  Swimming Pool                   1
Amusement Hall                  1             Distributor of Electricity         5             Motel                        $2.00/rm           Swimming Pool Service           1
Amusement Park                  1             Distributor of Gas                 5             Motor Freight Line           1                  TV Cable Service                1
Answering Service               1             Distributor of Water               5             Motor Veh. Dlr., Wholesale   2                  Tattooing                       1
Appraiser                       1             Document Examiner                  1             Motor Vehicle Carriers       1                  Taxicab                         1
Architects                      0.1% of Gross Dog Kennel or Grooming             1             Motor Vehicle Dlr, Retail    1                  Taxidermist                     1
Arena                           1             Draying                            1             Motor Vehicle Rentals        1                  Telephone                       5
Armored Car Service             1             Drilling/Svc. Oil Well             2             Motor Vehicle Repainting     1                  Theater                         1
Attorneys-At-Law                0.1% of Gross Driving School                     1             Motor Vehicle Repair         1                  Theatrical Booking 1
Auctioneer                      4             Electric Phonograph                $20.00        Motor Vehicle Storage        1                  Tourist Attraction              1
Auditing Freight Bills          0.1% of Gross Electrical Engineers               0.1% of Gross Moving & Storage             1                  Tourist Courts                  $2.00/rm
Auto Auction                    1             Electra Plating Service            1             Nursing Homes                1/3 Gross + $2/rm  Tow Boats                       1
Auto Club                       1             Elevator, Service to               1             Oculists                     0.1% of Gross      Towing                          1
Auto Title Service              1             Employees Screening                1             Office Building Renta        1                  Transportation                  1
Auto for Hire                   1             Employment Agency                  1             Oil & Gas Lease Broker       4                  Transportation by Boat          1
Bacteriologists                 0.1% of Gross Engineers                          0.1% of Gross Opera House                  1                  Trash/Garbage Pickup 1
Bail Bondsmen                   1             Engraver                           1             Operator of Office Bldgs     4                  Travel Agency                   1
Barber Shop                     1             Exhibition Show                    1Operator of Office Bldgs                  1                  Traveling Show                  $100.00 
Barge Line                      1             Figure Salon                       1             Osteopaths                   0.1% of Gross      Tree Cutting                    1
Baseball Machine                $20.00        Film Developing                    1             Packing & Crating Serv.      1                  Trolleys                        1
Baseball Park                   1             Film Production                    1             Parking Lot                  1                  Trucking                        1
Beauty Parlor for Dogs          1             Finance Company                    3             Patrol Service               1                  Truck Escort Service            1
Beauty School                   1             Financial Management               1             Pawn Broker                  1                  Truck Washing                   1
Beauty Shop                     1             Finger Printing & ID's             1             Peddler                      $100.00            Tug Boats                       1
Bill Boards                     1             Firing Range                       1             Petroleum Inspection         1                  Undertaker                      1
Billiard Table                  $20.00        Flea Market Participants           1             Photo Lab                    1                  Utility Company                 5
Billing Agency                  1             Food Broker                        4             Photographer                 1                  Vending Machine Oprtrs          1
Blue Prints                     1             Freezer Locker                     1             Physicians                   0.1% of Gross      Veterinarians                   0.1% of Gross
Boat Carriers-Freight           1             Freight Forwarding                 1             Pin Ball Machine             $20.00             Video Games                     $50.00 
Boat Carriers-Passengers        1             Freight Transportation             1Pipe Inspection                           1                  Warehouse                       1
Boat Landing                    1             Funeral Director                   1             Pipe Line Common Carrier     1                  Washateria                      1
Boat Launching                  1             Future Broker                      4             Pistols & Cartridges, Retail 1                  Security Service                1
Boat Mariner                    1             Garage                             1             Polygraph Examiner           1                  Wholesale Aircraft Dlr          2
Boats-Retail                    1             Garden Service                     1             Pool Table                   $20.00             Wholesale Dealer                2
BondingBondingCompaniesCompanies1 1           GeologicalGeological ServiceService1 1           PrintersPrinters             0.1%0.1%of Grossof GrossWholesaleWholesaleMtr VehiclesMtr2Vehicles2
Booking Agency                  1             Go Cart                            $20.00        Private Investigator         1                  Wholesale Pistols & Cart        2
Bowling Alley, Coin-Operated    $20.00        Computer Game                      $50.00        Private Postal Service       1                  Wired Music Service             1
Broker                          4             Golf Course                        1             Private Swim Club            1                  Wrecker Service                 1
Building Materials-Wholesale    2             Golf Practice Range                1             Produce Peddler              $100.00            Wrecking Yard                   1
Building Materials-Retai        2             Grain Commission House             4             Product Commission House     4
Bus Line                        1             Grain Elevator                     2             Professional Schools         1
Business Schools                1             Hauling                            1             Public Weigher               1
Cable Television                1             Hawkers                            $100.00       Race Track                   1
Campgrounds                     1             Health Studio/Health Club          1             Railways                     1
Car Wash                        1             Horse Show                         1             Real Estate Broker           4
Carpet Cleaning                 1             Hospitals (for profit)             1             Recording Studio             1
Catering Service                1             Hotel                              $2.00/rm      Refrigerated Lockers         1
Chemical Engineers              0.1% of Gross House Moving                       2             Renting Immovable Property   4
Chemists                        0.1% of Gross Information Service                1             Renting Immovable Property   2
Chiropodists                    0.1% of Gross Inspection & Testing               1             Renting Immovable Property   1
Circus                          $100.00       Instructional Schools              1             Repair Shop                  1
Civil Engineers                 0.1% of Gross Insurance Adjuster                 1             Rescue Service               1
Cleaning Service                1             Inventory Service                  1             Restaurant                   1
Coffee Houses                   1             Investment Counseling              1             Retail Dealer                1
Coin Operated Laundry           1             Irrigation Company                 1             Retail Dealer-Aircraft       1
Cold Storage                    1             Itinerant Vendors                  $100.00       Retail Dealer-No Fixed Place $100.00 
Collection Agency               1             Vendors of Agriculture Products  $100.00         Retail Dlr.-Certain Cons.    2
Commercial Artists              1             and Seafood Products                             Retail Motor Vehicles        1
Commercial Rating Agency        1             Jeweler                            1             Retail Pistols/Cartridges    1
Commission Broker               4             Juke Box                           $20.00        Retail Trailer Dealer        1
Common Carrier                  1             K-9 Training For Dog               1             Retail to Farmers            2
Computer Service                1             Laboratories                       1             Retail to Institutions       2
Concession                      1             Landscaping Service                1             Riding Academy               1                       This list             is   not      
Consultant                      1             Launderette                        1             Rooming House                $2.00/rm
Consulting Psychologist         1             Laundry                            1             Sales Promotion              1                       intended to   
Consumer Service                1             Leasing Movable Property           1             Sales of Membership          1
Contractor-Cost Plus            2             Letter Service                     1             Sales of Warranty            1                       include all   
Contractor-Direct. Drill        2             Lift Service                       1             Salvage Yard                 1
Contractor-Diving               2             Limousine Service                  1             Schools, Proprietary         1                       business types.                        
Contractor-Food Serv. Mgr.      2             Lithographers                      0.1% of Gross Self Defense Service         1
Contractor-Janitorial Service   2             Livestock Auctions                 4             Selling Cemetery Lots        1                       If you are               
Contractor-Lump Sum             2             Mailing & Composing Room           1             Service Businesses           1
Contractor-Oil Field Serv.      2             Management Control                 1             Service to Elevators         1                       unsure of   your                     
Contractor-Pest Control         2             Management Training                1             Ship Chandler                1
Contractor-Temp. Labor          2             Manufacturer's Agent               4             Shipbuilders                 2                       business type,                       
Contractor-Testing              2             Marine Surveyors                   1             Shooting Gallery, Mechanical $20.00 
Contractor-Testing Lab.         2             Masseur                            1             Shooting Gallery/Range       1                       please contact                       
Convention Promotion Con        1             Meat Cutting                       1             Sightseeing Tours            1
Copy Systems                    1             Mechanical Amusement Device $20.00/$50.00        Sign Painter                 1                       the Authority                       
Cotton Pickery                  4             Mechanical Engineers               0.1% of Gross Sitter Service               1
Credit Bureaus                  1             Mechanical Ride                    $20.00        Skating Rink                 1                       for assistance. 
Custodial Service               1             Mechanical Shoot Gallery           $20.00        Slaughter House              4
Dance Hall                      1             Medical Transportation Svc.        1Speedway Raceway                          1
Dealer in Stock & Bonds         4             Merchandise Broker                 4             Stable                       1

                                                                         INSTRUCTIONS

1. COMPLETE QUESTIONS 1 THROUGH 9.
2. SELECT EITHER NEW OR EXISTING BUSINESS AND COMPLETE THE APPROPRIATE SECTION.
           a.If you are a new business, the amount of license tax to be paid is stated.
           b. If you are an existing business registering for the first time, once the amount of sales receipts or commissions
           subject to license tax has been established, refer to the attached classification chart to determine the appropriate tax table.
             Find the occupational license tax due from the appropriate table below.
3. Make your remittance payable to "Ascension Parish Sales Tax".
5. Sign and initial your application and return the original copy along with your remittance.

                                                          Tax Tables
TABLE 1      RETAIL DEALERS          TABLE 3 Lending Business                                  TABLE 4 Commission Brokerage              Flat Fees- Calculation 5
RS 47:354                            RS 47:356                                                 RS 47:357
If The Gross              The Annual If The Gross         The Annual                           If The Gross             The Annual       1. Private Investment Agency-$500
Sales Are:   But          License    Sales Are:       But License                              Sales Are:    But        License          R.S. 47:359 (A)
As Much As   Less Than Shall Be      As Much As       Less Than Shall Be                       As Much As    Less Than Shall Be
$0           50,000                  50    $0             250,000                         50    $0           15,000                  50  2. Peddlers and Itinerant Venders-$100
50,000       75,000                  60    250,000        500,000                         100   15,000       20,000                  70  Includes:
75,000       100,000                 90    500,000        750,000                         150   20,000       25,000                  90  Selling by Display of samples R.S. 47:359 ( C )
100,000      150,000                 120   750,000        1,000,000                       200   25,000       30,000                  115 Peddling Hawking R.S. 47:359 ( C )
150,000      200,000                 180   1,000,000      1,250,000                       250   30,000       40,000                  137 Itinerant Venders R.S. 47:359 ( C )
200,000      250,000                 250   1,250,000      1,500,000                       300   40,000       50,000                  180
250,000      300,000                 300   1,500,000      1,750,000                       350   50,000       65,000                  225 3. Amusement Machines- 47:359
300,000      400,000                 360   1,750,000      2,000,000                       400   65,000       80,000                  300
400,000      500,000                 500   2,000,000      2,250,000                       450   80,000       100,000                 360 4. Professional Sports-$1000
500,000      600,000                 650   2,250,000      2,500,000                       500   100,000      125,000                 450 R.S. 47:359 (G)
600,000      750,000                 800   2,500,000      3,000,000                       550   125,000      150,000                 600
750,000      1,000,000               900   3,000,000      3,500,000                       600   150,000      175,000                 675 5. Circuses, Concerts, Carnivals and Special Events-$100
1,000,000    1,500,000               1200  3,500,000      4,000,000                       650   175,000      200,000                 750 R.S. 47:359 (H)
1,500,000    2,000,000               1,800 4,000,000      4,500,000                       700   200,000      250,000                 900
2,000,000    2,500,000               2,400 4,500,000      5,000,000                       750   250,000      300,000               1,050 6. Hotels, Motels, and Rooming Houses $2.00 per room
2,500,000    3,000,000               3,000 5,000,000      5,500,000                       800   300,000      350,000               1,200 R. S. 47:359 (I) (Use Calculation 4)
3,000,000    3,500,000               3,600 5,500,000      6,000,000                       850   350,000      400,000               1,400
3,500,000    4,000,000               4,200 6,000,000      6,500,000                       900   400,000      450,000               1,600
4,000,000    4,500,000               4,800 6,500,000      7,000,000                       950   450,000      500,000               1,800
4,500,000    5,000,000               5,400 7,000,000      7,500,000                       1,000 500,000      550,000               2,000
5,000,000    5,500,000               6,000 7,500,000      8,000,000                       1,050 550,000      600,000               2,200 Nursing Homes-$2.00 per room R.S. 47:359(1)
5,500,000 *********                  6,200 8,000,000      8,500,000                       1,100 600,000      650,000               2,400 plus 1/3 of gross receipts R.S. 47:354
TABLE 2 WHOLESALE DEALERS                  8,500,000      9,000,000                       1,150 650,000      700,000               2,600
RS 47:355  Contractors                     9,000,000      9,500,000                       1,200 700,000      750,000               2,800
                                           9,500,000      10,000,000                      1,250 750,000      800,000               3,000
If The Gross              The Annual       10,000,000     11,000,000                      1,350 800,000      850,000               3,200
Sales Are:   But          License          11,000,000     12,000,000                      1,450 850,000      900,000               3,400
As Much As   Less Than Shall Be            12,000,000     13,000,000                      1,550 900,000      950,000               3,600 Pawnbroker- Basis shall include total
                                           13,000,000     14,000,000                      1,650 950,000 ***********                3,700 loans plus retail sales with a
$0           100,000                 50    14,000,000     15,000,000                      1,750 TABLE 5             Public Utilities     minimum license of $300 R.S. 47:354
100,000      150,000                 75    15,000,000     16,000,000                      1,850 RS 47:358
150,000      250,000                 100   16,000,000     17,000,000                      1,950
250,000      500,000                 150   17,000,000     18,000,000                      2,050 If The Gross            The Annual
500,000      600,000                 200   18,000,000     19,000,000                      2,150 Sales Are:   But        License
600,000      800,000                 250   19,000,000     20,000,000                      2,250 As Much As   Less Than Shall Be
800,000      1,000,000               300   20,000,000     25,000,000                      2,500                                          Other Professional Businesses
1,000,000    1,500,000               400   25,000,000     30,000,000                      3,000 $0           20,000                  50  License tax shall be one-tenth of one percent of the
1,500,000    2,000,000               500   30,000,000     35,000,000                      3,500 20,000       25,000                  60  annual gross receipts for professional fees for services
2,000,000    2,500,000               700   35,000,000 ************                        3,700 25,000       37,500                  75  rendered
2,500,000    3,000,000               900                                                        37,500       50,000                  115
3,000,000    4,000,000               1,000 Businesses under Sections 47:354 & 47:355            50,000       75,000                  150 Minimum Tax    $50.00
4,000,000    5,000,000               1,250 with less than $2,500.00 of annual gross             75,000       100,000                 200 Maximum Tax    $2000.00
5,000,000    5,500,000               1,800 receipts (one full year) shall pay no license        100,000      150,000                 300
5,500,000    6,000,000               2,400 taxes for the current year. The business shall       150,000      200,000                 450 Including but not limited to the following businesses:
6,000,000    6,500,000               3,000 continue to file an application for each year.       200,000      250,000                 650 Printers, Lithographers, Editors, Publishers,
6,500,000    7,000,000               3,600                                                      250,000      500,000                 750 Attorneys-At-Law, Accountants, Oculist, Physicians,
7,000,000    7,500,000               4,200                                                      500,000      750,000               1,500 Osteopaths, Dentists, Chiropodist, Bacteriologists,
7,500,000    8,000,000               4,800                                                      750,000      1,000,000             2,250 Veterinarians, Chemist, Architects, and Civil Mechanical,
8,000,000    9,000,000               5,200                                                      1,000,000    1,250,000             3,000 Chemical or Electrical Engineers engaged in the practice
9,000,000 10,000,000                 5,600                                                      1,250,000    1,500,000             3,750 of their profession as an individual, or as a firm,
10,000,000 11,000,000                6,000                                                      1,500,000    1,750,000             4,500 partnership, or corporation. ( The tax levied herein shall
11,000,000 12,000,000                6,400                                                      1,750,000    2,000,000             5,250 be levied only on the business and not separately on any
12,000,000 13,000,000                6,800                                                      2,000,000    2,250,000             6,000 individual who is employed by or is a member of the
13,000,000 14,000,000                7,200                                                      2,250,000    2,500,000             6,900 taxpayer which conducts its business as a firm,
14,000,000   ************            7,500                                                      2,500,000  ************            7,500 partnership, or corporation.
Note: Contractors                                                                                                                       NOTE: WHEN A BUSINESS HAD STARTED ON OR AFTER
Minimum Tax $50.00                                                                                                                            JULY 1ST OF ANY YEAR, THE INITIAL TAX DUE
Maximum Tax $750.00                                                                                                                           SHALL BE ONE HALF OF THE MINIMUM ANNUAL RATE.

                                                                   ALLOWED DEDUCTIONS

                                           1. Petroleum taxes as defined in R.S. 47:361.A
                                           2. For Undertaking and Funeral directing refer to R.S. 47:361 B
                                           3. For applicable deductions in the brokerage of stocks and bonds see R.S. 47:361.C
                                           4. Retail Sales of Motor Vehicles and Boats with gross receipts exceeding $700,000.00 refer to R.S. 47:361D