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REMIT ALL PAYMENTS TO: PLEASE INDICATE ANY CHANGES BELOW
Date out of business Date business sold
BIENVILLE PARISH SALES & USE TAX COMMISSION
P.O. BOX 746 Name of New Owner
ARCADIA, LOUISIANA 71001
(318) 263-9416 Mailing address change
www.laota.com Location address change
SALES AND USE TAX REPORT Acct #: Sales for Month of ____________ 20____
(or last month of reporting period)
(Do Not use any other taxpayer's return as this may result in improper credit.)
1. GROSS SALES OF TANGIBLE PERSONAL PROPERTY, LEASES, RENTALS, AND SERVICES REPORTED TO STATE OF LOUISIANA
SCHEDULE "A" ALLOWABLE DEDUCTIONS
2. SALES FOR RESALE REPORT EVEN DOLLAR AMOUNTS
3. CASH DISCOUNTS, SALES RETURNS & ALLOWANCES ROUND UP ANY AMOUNT .50 & OVER
4. SALES DELIVERED OR SHIPPED OUTSIDE OF BIENVILLE PARISH DROP ANY AMOUNT .49 & BELOW
5. SALES OF GASOLINE AND MOTOR FUELS
6. SALES TO US GOV'T, STATE OF LA, POLITICAL SUBDV. & LOCAL AGENCIES DO NOT IGNORE DELINQUENT NOTICES
7. SALES OF FOOD PAID WITH USDA FOOD STAMPS OR WIC VOUCHERS NEGLIGENCE PENALTIES MAY BE
OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY) IMPOSED
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9 Make a copy for your records
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11. TOTAL ALLOWABLE DEDUCTIONS (LINE 2 THRU 10)
12. ADJUSTED GROSS SALES (LINE 1 MINUS LINE 11)
COMPUTATION OF SALES AND USE TAX COMPLETE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS
THISPERIODRETURNCOVEREDIS DUEBYONTHISTHERETURN1ST DAYANDOFBECOMEMONTH FOLLOWINGDELINQUENT 5.50%A 5.00%B 5.00%C 4.00%D 3.00%E 4.00%F
IF NOT RECEIVD BY THIS OFFICE PRIOR TO THE 21ST DAY. TOWN OF ARCADIA TOWN OF GIBSLAND TOWN OF RINGGOLD VILLAGE OF CASTOR RURAL VILLAGE OF SALINE
SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD
& POLICE JURY & POLICE JURY & POLICE JURY & POLICE JURY & POLICE JURY & POLICE JURY
13. ADJUSTED GROSS SALES IN EACH JURISDICTION
14. PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION
15. TOTAL TAXABLE TRANSACTIONS (LINE 13 PLUS LINE 14)
16. TAX DUE (MULTIPLY LINE 15 BY THE TAX RATE OF EACH COLUMN)
17. EXCESS TAX COLLECTED
18. TOTAL TAX DUE (LINE 16 PLUS LINE 17)
19. VENDORS COMPENSATION (2% LINE 18) (ONLY IF PAYMENT IS NOT DELINQUENT)
20. NET TAX DUE (LINE 18 MINUS LINE 19)
21. PENALTY (5% of Tax for each 30 Days or Fraction Thereof, 25% Max)
22. INTEREST (6% PER ANNUM CALCULATED FROM DATE DUE UNTIL PAID)
23. TOTAL TAX, PENALTY, AND INTEREST DUE (SUM OF LINES 20-22)
24. TAX DEBIT OR CREDIT (AUTHORIZED MEMO MUST BE ATTACHED)
25. TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)
26. TOTAL REMITTED(TOTAL OF LINE 25 COLUMNS A, B, C, D, E) HAVE YOU USED THE PROPER COLUMN? $HAVE YOU USED THE PROPER COLUMN?
I declare under the penalties for filing false reports that this return (including any accompanying schedules) has been examined by me and to the best of my
knowledge and belief is a true, correct, and complete return. If the return is prepared by a person other than this taxpayer, his declaration is based on all the information relating
to the matters required to be reported in the return of which he has any knowledge
This return is DUE on the 1st day of the month following the period covered by this return and becomes DELINQUENT if not received by this office prior to the 21st day
DATE PREPARED SIGNATURE OF INDIVIDUAL OR AGENT & PHONE NUMBER SIGNATURE OF PREPARER & PHONE NUMBER CHECK NUMBER
Phone Number for Contact person Reviewed By Reviewed By
$15.00 CHARGE ON ALL RETURNED CHECKS
BIENVILLE PARISH SALES & USE TAX COMMISSION
P.O. BOX 746
ARCADIA, LOUISIANA 71001
Account No.
La. Tax ID:
SALES TAX FORM ENCLOSED
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