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                                                                                                                                                                                                     EVANGELINE PARISH                     PRSRT STD
    SALES AND USE TAX REPORT                                                                                                         REVISED 7/1/21                                                  SALES/USE TAX COMMISSION              U.S.
                                                                                                                                                                                                                       PH 337-363-3004     POSTAGE PAID
                                                                                                                                                                                                                                           VILLEPLATTE,LA
    PLEASE INDICATE ANY CHANGES BELOW                                                                                                                                                                                  FAX 337-363-5418    PERMITNO.9
    DATE OUT OF BUSINESS _______________ DATE BUSINESS SOLD ________________                                                                                                                                           P.O. BOX 367
                                                                                                                                     MONTH OF _____________ YR. ______                               VILLE PLATTE, LA 70586-0367
    NAME OF NEW OWNER _____________________________________________________
1. Gross sales of tangible personal property, leases, rentals and                                                                                                                                    RETURN SERVICE GUARANTEED
    services as reported to the State of Louisiana. (Before Taxes)                                     $
                   ALLOWABLE DEDUCTIONS
2. Sales for Resale
3. Cash Discounts, Sales Returns & Allowances
                                                                                                                                     STATE TAX I.D. # ___________________________
4. Sales Delivered or Shipped Outside of Parish                                                                                                                                                    ACCOUNT # ______________________________
5. Sales of Gasoline and Motor Fuels
6. Sales to the U.S. Govt., the State of LA, its Political Sub.
7. Sales of Food Paid for with USDA Food Stamps or WIC Vouchers
    OTHER DEDUCTIONS Authorized by law (Explain briefly)
8.
9.
10.
11. Total allowable deductions (Line 2 thru 10)
12. Adjusted gross sales (Line 1 minus 11)
                                                                                                                                                          OFFICE USE ONLY

                                                                                                                                     COMPLETE ONLY THOSE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS
COMPUTATION OF SALES AND USE TAX                                                                       Column A 6%                   Column B 6%          Column C 6%         Column D 6%          Column E 6%         Column F 6%         Column G 6%
                                                                                                       All Rural Sales               Town of Ville Platte Town of Basile      Town of Pine Prairie Town of Chataignier Town of Mamou       Town of Turkey Creek
                                                                                                       School Board, Solid           School Board, Solid  School Board, Solid School Board, Solid  School Board, Solid School Board, Solid School Board, Solid
                                                                                                       Waste, & Sheriff              Waste, & Sheriff     Waste, & Sheriff    Waste, & Sheriff     Waste, & Sheriff    Waste, & Sheriff    Waste, & Sheriff
13. Adjusted Gross Sales in Each Jurisdiction                                                       13.
14. Purchases Subject to Use Tax In Each Jurisdiction
15. Total (Line 13 plus Line 14)
16. Multiply Line 15 by % Shown (Each Column)                                                       16.
17. Excess Tax Collected
18. Total (Line 16 plus Line 17)
19. Vendors Compensation (2% of Line 18)(Deductibleis not Delinquent)only if Payment                19.
20. Net Tax Due (Line 18 minus Line 19)
21. Delinquent Penalty  thereof of delinquency, maximum 25%)(5% of tax for each 30 days or fraction 21.
22. Interest: 1% per month from due date until paid                                                 22.
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)                                                25.
This Return is due on the 1st day of the month following the period covered by                         Audited By                                     Total of Columns A & B & C & D & E & F & G & H                       Total Remittance
this return and becomes delinquent if not transmitted on or before the 20th day.                                                                                                                                       26. $
I declare under the penalties for filing false reports that this report has been examined by me and to the best of my knowledge                       $20.00 CHARGE ON ALL “NSF” CHECKS
and belief is a true, correct and complete report. If the report is prepared by a person other than the taxpayer, his declaration is                                                                                                    REMITTANCE PAYABLE
based on all the information relating to the matters required to be reported in the return of which he has any knowledge.                                                                                                          Evangeline Parish Tax Commission
Signature of                                                                                                                                                                  ORIGINAL
Owner or Agent ___________________________________________________________________________ Date ____________________________






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