CITY OF BATON ROUGE/PARISH OF EAST BATON ROUGE
                                   DEPARTMENT OF FINANCE - REVENUE DIVISION
                                   PO BOX 2590, Baton Rouge, LA  70821-2590
                                   Phone (225)389-3084  Fax (225)389-5369
                                         www.brla.gov/659/Taxes

   Application for Exemption from Collection of Sales Tax for Certain Fund Raising Activities
   A separate application for exemption must be submitted for each fund raising activity

   This application for exemption is applicable for the following political subdivisions:
   CITY OF BATON ROUGE                                    CITY OF CENTRAL
   PARISH OF EAST BATON ROUGE                             CENTRAL COMMUNITY SCHOOL DISTRICT
   EAST BATON ROUGE PARISH SCHOOL BOARD                   CITY OF ZACHARY
   CITY OF BAKER                                          ZACHARY COMMUNITY SCHOOL DISTRICT
   BAKER SCHOOL DISTRICT

1. Nature of domestic non-profit organization: (check one)
   Civic                           Fraternal              Educational

   Religious                       Charitable             Historical

2. Nature of activity:

3. Location and dates of activity:

4. Entire proceeds except for the necessary expense connected therewith are to be used for: (Check One)

   Educational Purposes                       Name

   Charitable Purposes                        Name

   Religious Purposes                         Name

   Historical Purposes                        Name

   NOTE:  Any organization or individual who fraudulently signs this request shall be subject to penalties provided
   by applicable regulations.

                                                                                         Organization

   For office Use Only:      Date:
                                                                                         Address
   Approved                        Denied
                                                          Contact Person Name        /   Phone No.         / Fax No.  

   Authorized Signature                                                                  Contact email address     

                             Title                                                       Authorized Signature/Title

   THIS FORM MUST BE ACCOMPANIED BY AN APPROVED STATE OF LOUISIANA FORM R-1048.