Sales and Use Tax Report                                                                                              
  PARISH  OF  EAST FELICIANA                                                                                             BUSINESS NUMBERS 
  SALES AND USE TAX DEPARTMENT                                                                                           225-683-8277 - PHONE 
  P.O. BOX 397                                            Parish Tax ID Number:                                          225-683-3320 - FAX 
  CLINTON, LA 70722                                                                                                      THIS RETURN IS DUE ON THE 1ST 
 
     To avoid penalties be sure that                      Vendor Name:                                                   DAY OF THE MONTH FOLLOWING 
     you transmit this return on or                                                                                      PERIOD COVERED BY THE RETURN 
     before the 20th of each month                        Address:                                                       AND BECOMES DELINQUENT ON 
     following the period covered.                                                                                       21ST DAY 
                                                          City, State, Zip:                                       
                                                           
                                         Period Covered                                                      20           
 
                                                                              5% Parish                                 DO NOT USE THESE COLUMNS 
                                                                                                                                                          
                                                                     $                                        $            $          $         $ 
  1. Gross sales of tangible personal property,                                                                                                           
     leases, rentals, and services as reported to the 
     State of Louisiana 
                                                       SCHEDULE "A" ALLOWABLE DEDUCTIONS 
  2.  Sales for resale.                                                                                                                                   
  3.  Cash discounts, sales returns & allowances.                                                                                                         
  4.  Sales delivered or shipped outside this jurisdiction.                                                                                               
  5.  Sales of gasoline and motor fuels.                                                                                                                  
  6. Sales to U.S. Gov't., State of LA & its political                                                                                                    
     subdivisions and agencies. 
  7.  Food paid for with USDA food stamps or WIC vouchers.                                                                                                
  8.                                                                                                                                                      
  9.                                                                                                                                                      
  10.                                                                                                                                                     
  11. Total allowable deductions (line 2 thru 10).                                                                                                        
       COMPUTATION OF SALES AND USE TAX                                                                      HAVE YOU USED THE PROPER COLUMN?             
  12.  Adjusted gross sales (Line 1 minus 11).                                                                                                            
  13.                                                                                                                                                     
  14.  Purchases subject to use tax in each jurisdiction.                                                                                                 
  15.  Total (Line 12 plus 14).                                                                                                                           
  16.  Tax (5% of Line 15).                                                                                                                               
          16a.  Total of Out of State Repairs $ ___________ x 2%                                                                                          
  17.  Excess tax collected.                                                                                                                              
  18.  Total (Line 16 plus line 17).                                                                                                                      
  19. Vendor's Compensation (2% of line 18, deductible                                                                                                    
       only when payment is not delinquent). 
  20.  Net tax due (line 18 minus line 19).                                                                                                               
  21. Delinquent Penalty (5% of tax for each 30 days or fraction                                                                                          
       there of delinquency not to exceed 25% in the aggregate). 
  22.  Interest (1 1/4% per month from due date until paid).                                                                                              
  23.  Total tax, penalty and interest due.                                                                                                               
  24.  Tax debit or credit (Authorized memo must be attached).                                                                                            
  25.  Total amount due (Line 23 plus or minus line 24).                                                                                                  
                                                                                                                                                
  26. REMITTANCE ATTACHED (TOTALS OF ALL COLUMNS)---------------------------                                                       $ 
  
  I declare under penalties for filing false reports that this return (including any accompanying schedules                        La Tax Identification 
  and statements) has been examined by me and to the best of my knowledge and belief is a true, correct,                                Number 
  and complete return. If the return is prepared by a person other than the taxpayer, his declaration is 
  based on all the information relating to the matter required to be reported in the return of which he has 
  any knowledge. 
  WARNING: DO NOT USE ANY OTHER TAXPAYERS RETURN AS THIS                                                         Date:                                    
  WILL RESULT IN IMPROPER CREDIT!                                                 Authorized Signature:                                                    
  MAKE YOUR REMITTANCE ON ONE CHECK PAYABLE TO EAST FELICIANA PARISH SALES TAX FUND.