SALES AND USE TAX REPORT City of Baton Rouge - Parish of East Baton Rouge
Make Remittance Payable To: Dept.P O Boxof Finance2590 - Revenue Division BUSINESS NAME:
PARISH AND CITY TREASURER Baton Rouge, LA 70821-2590Phone 225-389-3084 Fax 225-389-5369 ACCOUNT NUMBER
www.brla.gov/659/Taxes PERIOD COVERED 20
ROUND ALL NUMBERS AND YOUR CHECK TO THE NEAREST DOLLAR FOR OFFICE USE ONLY
POSTMARK DATE
1. GROSS SALES OF TANGIBLE PERSONAL PROPERTY, LEASES, RENTALS, AND *99999999* TRANSACTION TYPE
SERVICES AS REPORTED TO THE STATE OF LOUISIANA
ALLOWABLE DEDUCTIONS PLEASE INDICATE ANY CHANGES BELOW:
2. SALES FOR RESALE OR FURTHER PROCESSING CHECK #
3. CASH DISCOUNTS, SALES RETURNS AND ALLOWANCES
4. SALES DELIVERED OUTSIDE EAST BATON ROUGE PARISH TOTAL REMITTED
5. SALES OF GASOLINE AND MOTOR FUELS DATE BUSINESS SOLD NAME OF NEW BUSINESS
6. SALES TO GOVERNMENTAL AGENCIES $15.00 CHARGE ON ALL TOTAL OF COLUMNS
7. SALES OF FOOD PAID W/FOOD STAMPS OR WIC VOUCHERS "NSF" CHECKS A,B,C,D,E,F,G & H (line 25)
OTHER DEDUCTIONS ALLOWED BY LAW(Explain Briefly) This return is DUE on the 1st day of the month DATE BUSINESS CLOSED BUSINESS LOCATION CHANGE
8 following the period covered by this return and
9 becomes DELINQUENT if not postmarked prior to
10 the 21st day. CHANGE IN NAME OF BUSINESS MAILING ADDRESS CHANGE
11. TOTAL ALLOWABLE DEDUCTIONS (Sum of Lines 2-10) $ -
12. ADJUSTED GROSS SALES (Line 1 less Line 11) $ -
LOCAL TAX RATES A - 5.5% B - 5.5% C - 5.5% D - 6% E - 6% F - 5.5% G - 6% H - 6% K - 6.5%
CITY OF BATON ROUGE PARISH OF EBR PARISH OF EBR CITY OF BAKER CITY OF BAKER CITY OF ZACHARY CITY OF CENTRAL PARISH OF EBR AMERICANA EDD
EBR PARISH EBR PARISH ZACHARY BAKER EBR PARISH ZACHARY CENTRAL CENTRAL ZACHARY
SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT SCHOOL DISTRICT
13. ADJUSTED GROSS SALES IN EACH JURISDICTION
(TOTAL OF COLUMNS MUST EQUAL LINE 12)
14. PURCHASES SUBJECT TO USE TAX BY JURISDICTION
15. TOTAL (LINE 13 PLUS LINE 14)
16. TAX DUE (Multiply line 15 by % shown in proper column)
16a. SALES OF FOOD, DRUGS, & MEDICAL ITEMS
16b. FOOD, DRUG & MEDICAL ITEM DEDUCTIBLE
(2.5% of 16a EXCEPT 1.5% for Columns D, G, and H)
16c. NET TAX DUE (Line 16 less Line 16b)
17. EXCESS TAX COLLECTED
18. TOTAL TAX DUE (Line 16c plus Line 17)
19. VENDOR'S COMPENSATION (1% of Line 18)
DEDUCTIBLE ONLY WHEN PAYMENT IS NOT DELINQUENT
20. NET TAX DUE (Line 18 less Line 19)
21. DELINQUENT PENALTY
(5% of tax for each 30 days or fraction thereof delinquent, 25% max)
22. INTEREST (15% per annum from date until paid)
23. TOTAL TAX, PENALTY AND INTEREST DUE
(Sum of Line 20 - 22)
24. TAX DEBIT OR CREDIT (Authorized memo must be attached)
25. TOTAL AMOUNT DUE (Line 23 less Line 24)
I declare under penalties for filing false reports that this return, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge is a true, correct, and complete return.
DATE AUTHORIZED SIGNATURE PHONE NUMBER LA TAX IDENTIFICATION NUMBER