REMIT ALL PAYMENTS TO: PRSRT-STD
PARISH OF GRANT U.S. POST AGE
SHERIFF STEVEN McCAIN PAID
C O LFAX, LA
SALES AND USE DEPARTMENT Permit No. 16
P. 0. BOX 187
COLFAX,LA 71417
RETURN SERVICE REQUESTED PERIOD COVERED ____ __ 20 _
GROSS SALES OF TANGIBLE PERSONAL PROPERTY, LEASES, RENTALS
1 . AND SERVICES AS RE?ORTED TO THE STATE OF LOUISIANA 1.
( SALES AND USE TAX REPORT)
ALLOWABLE DEDUCTIONS FOR O FF CE USE ON Y I L
2. SALES FOR RESALE OR FURTHER PROCESSING(CERTIFICATE ON FILE) To avoid penalties your envelope must have an official postmark dated
on or before the 20th following the period covered by the return.
3. CASH DISCOUNTS, SALES RETURNS & ALLOWANCES
4. SALES DELIVERED OR SHIPPED OUTSIDE GRANT PARISH PLEASE NDI CAIE ANYT CHANGES BELOW:
5. SALES OF GASOLINE AND MOTOR FUELS
6. SALES TO THE US GOVT., THE STATE OF LA, ITS POLITICAL SUBDIVISIONS AND AGENCIES DATE BUSI NESS SOLD NAME AND ADDRESS OF PURCHASER
7. SALES OF FOOD PAID FOR WITH USDA FOOD STAMPS OR WIG VOUCHERS
OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY) DATE BUSINESS DISCONTINUED BUSINESS LOCATION CHANGE
8. CHANGE IN NAME OF BUSINESS MAILING ADDRESS CHANGE
9.
10. CONSOLIDATED SALES & USE TAX REPORT FOR GRANT PARISH
11. TOTAL ALLOWABLE DEDUCTIONS ( LINE 2 THROUGH LINE 10) 11. COMPLETE ONLY COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS
12. ADJUSTED GROSS SALES (LINE1 MINUSLIN E 11) 12.
TOTAL LOCAL RATE A-4% r6% C-5% D-6% E-60/o F-5 % C:, 5'l- o
PARISH WIDE TAX � PARISH (P.J.) PARISH (P.J.) PARISH (P.J.) PARISH (P.J.) PARISH (P.J.) PARISH (P.J.) PARISH (P.J.)
PARISH WIDE TAX � SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD SCHOOL BOARD
LAW ENFORCEMENT TAX � LAW ENF. LAW ENF. LAW ENF. LAW ENF. LAWENF. LAW ENF. LAW ENF
MUNICIPALITY TAX � COLFAX POLLOCK GEORGETOWN CREOLA MONTGOMERY DRY PRONG
�1}Et�t�i 1 3 .
14. PURCHASES SUBJECTTO USE TAX IN EACH JURISDICTION 14.
15. TOTAL (LINE 13 PLUS LINE 1� 15.
16.TAX DUE- MULTI PLYNELI \5 BY%SHONN IN PROPER COLUMN16.
17. EXCESS TAX COLLECTED 17.
18. TOTAL (LINE 16 PLUS LINE 17) 18.
VENDOR'S COMPENSATION 2% OF LI NE 81 PmENTOEOUCTIUON.ISNOT ce.JNOUEHT \' l,IEN
19. 19
20. NET TAX DUE(LINE 18M NUS I NELI 19) 20.
Delinqu ne t 5%f x f o ta orc 30 ys f c n ea h da or ra tio threo f not
21 . Pen y alt toxc e eed 2 5%n i thegg g a re ate 21
22. INTEREST (12% per annum from date until paid) 22.
23. TOTAL TAX, PENALTY AND INTEREST DUE 23.
24.TAX DEBIT OR CREDIT(AUTHOAIZEOMEMOMUST8EATTACHE) 24.D
25.TOTAL AMOUNT DUE(LINE 23 PLUS OR MINU S LINE 24)25.
REMITTANCE ATTACHED Totals of( MAKE YOUR R M TTA CE I N E GRANT PARISH SALES TAX FUND Line TOTAL REMITTED CHECK NUMBER
26· co sl : A, B, , C D, E,F G,H & ,) I PAYABLE TO : _ _ �- _ _(_Mail to the Above Addres& _ tfl&\1'19� 26 $
I declare under the penalties for filing false reports hatt this return (including any accompanying schedules and statements) has been examined by BUSINESS LOCATION
me and to the best of my knowledge and belief is a true, correct, and complete return. If the return is prepared by a person other than the taxpayer,
hsi declaration is based on all the in ormatonf irelating to the matters required to be reported in the return of which he has any knowledge. "Returns
by taxpayer previously registered by Grant Parish, shall extend registration to all tax ngi jurisdictions."
$25.00 CHARGE ON DATE I AUTHORIZED SIGNATURE I PHONE NUMBER REVIEWED BY
ALL "NSF" CHECKS ( )
06112