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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            RESERVED                                   Boom Town

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               TOTAL REMITTED                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    OFFICE USE ONLY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               LINE 26.                                                                                                                                                                                                                                                                             REMITTANCES PAYABLE TO                      BOSSIER CITY - PARISH
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      OFFICE USE ONLY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              4.25% F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SALES AND USE TAX DIVISION                                           DATE 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         POLICE JURY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                LAW ENFORCEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   2.5% E*
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         POLICE JURY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                LAW ENFORCEMENT

                                                                                                                                                                                                                                                                                                                                                                                                                                  YR                                                                                                                                                                                                                                                                                                                                                                            DATE BUSINESS SOLD

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   5.25% D
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         PLAIN DEALING                 POLICE JURY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                                           LAW ENFORCEMENT
                                                                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     CONSOLIDATED SALES & USE TAX REPORT FOR BOSSIER PARISH, LA.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                COMPLETE ONLY THOSE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      OFFIC E USE ONLY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         HAUGHTON                                                  5.25%% C
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                               POLICE JURY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   LAW ENFORCEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                DO NOT use any other taxpayer's return as this will result in impropert credit.                                                                        DO NOT ignore delinquent notices - Negligence penalties may be imposed.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         BENTON                                                    5.25% B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          STATE TAX I.D.#
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                               POLICE JURY
                                                                                                                                                                                                                                                                                                                                                                                                                                          MONTH(S) OF                                                                                                                                                                                                                                                                                                                    PLEASE INDICATE ANY CHANGES BELOW:               DATE OUT OF BUSINESS                                           NAME OF NEW OWNER                                              COMMENTS:                                                                                                                                                                                  LAW ENFORCEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       TOTAL OF COLUMNS  A  +  B  +  C  +  D  +  E  +  F                                                                                                              *THIS AREA IS ALSO WITHIN THE CITY OF SHREVEPORT                                                                                                                                                                                                                                          WARNING:
                                                                                                                                                                                                                                                                                                                                                                                                              
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  SIGNATURE OF                                                INDIVIDUAL OR AGENT

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   5% A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         BOSSIER CITY                  POLICE JURY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             AUDITED BY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SCHOOL BOARD                                           LAW ENFORCEMENT
                                                                                                                                                                                                                                                                                                                                                      1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              11                                                                                                                                                                                                                                                                                                        13                                        14                                                                             16                                             17                                                                               19                                                                                                                    21                                                                                                                          22                                                            24                                                                                                     25

                                                                                                                                                                                                                                                                  WWW.LAOTA.COM

                                                                                                                                                                                                                                                                   AND 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                TOTAL OF COLUMNS               
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               MUST  EQUAL LINE 12                                                                                                                                                                                                       DEDUCTIBLE ONLY WHEN           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        PAYMENT IS NOT DELINQUENT

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      CALCULATED FROM DATE DUE UNTIL PAID.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               5% OF TAX FOR EACH 30 DAYS OR FRACTION THEREOF                                             COMPUTED FROM THE 21st. DELINQUENCY, NOT TO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     ORIGINAL
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
                                                                                                                                                                                                                                                                  WWW.BOSSIERCITY.ORG                                                                                                                         ALLOWABLE DEDUCTIONS

                                                                                                                                                                                                                  PHONE NO:  318-741-8549    FAX NO:  318-741-8997
USE PAPER CLIPS TO ATTACH REMITTANCE                         BOSSIER CITY - PARISH SALES AND USE TAX DIVISION                                                   P.O. BOX 71313  BOSSIER CITY, LOUISIANA 71171-1313
                                     SALES AND USE TAX REPORT
                                                                                                                                                                                                                                                                  ON THE WEB AT 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              ACCT :
                                                                                                                                                                                                                                                                                       GROSS SALES OF TANGIBLE AND PERSONAL PROPERTY, LEASES, RENTALS     AND SERVICES AS REPORTED TO THE STATE OF LOUISIANA                                           SALES FOR RESALE OR FURTHER PROCESSING (CERTIFICATE ON FILE)  CASH DISCOUNTS, SALES RETURNS & ALLOWANCES  SALES DELIVERED OR SHIPPED OUTSIDE THIS JURISDICTION  SALES OF GASOLINE AND MOTOR FUELS                                                     SALES TO AGENCIES OF THE US GOVERNMENT, THE STATE      OF LOUISIANA AND ITS POLITICAL SUBDIVISIONS  SALES OF FOOD PAID FOR WITH USDA FOOD STAMPS OR WIC VOUCHERS.         OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)                           TOTAL ALLOWABLE DEDUCTIONS (LINE 2 THRU 10)                ADJUSTED GROSS SALES (LINE 1 MINUS LINE 11)                                                                                       COMPUTATION OF SALES AND USE TAX                                  TOTAL RATE                                ADJUSTED GROSS SALES IN EACH JURISDICTION PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION TOTAL (LINE 13 PLUS LINE 14) TAX DUE- MULTIPLY LINE 15 BY % SHOWN IN COLUMN EXCESS TAX COLLECTED TOTAL (LINE 16 PLUS LINE 17)                                VENDORS COMPENSATION 1% OF LINE 18 NET TAX DUE (LINE 18 MINUS LINE 19)                                                DELINQUENT PENALTY                                                                                                          INTEREST .750 % PER MONTH TOTAL TAX, PENALTY AND INTEREST DUE TAX DEBIT OR CREDIT (AUTHORIZED MEMO MUST BE ATTACHED)                                                 TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)
                                                                                                                                                                                                                                                                                                                                                      1                                                                                               2                                                             3                                           4                                                     5                                                                                     6                                                                                                   7                                                                                                                           8   9                 10 11                                                         12                                                                                                                                                                                                                                             13                                        14                                                15                           16                                             17                   18                                                          19                                 20                                                                                 21                                                                                                                          22                        23                                  24                                                                                                     25                                                   This return DUE  on the 1st day of month following period covered by this return                                                                                 and  becomes DELINQUENT if not transmitted on or before the 20th day. 






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