This report  DUEis on  the 1st day of the                   REMIT TO:
                                                                                                    Check #: 
month following period covered by            IBERVILLE PARISH SALES TAX
     the report, and becomes                          DEPARTMENT                                    Postmark Date: 
     DELINQUENT ON 21ST         DAY          P.O. Box 355 • Plaquemine, LA 70765-0355               Date Received: 
FORM EFFECTIVE DECEMBEh    2022 TAX   PERIOD   SALES      & USE TAX REPORT                               Receipt #: 
                                             Ph.(225) 687-5200 • Fax (225) 687-5226                 Receipt Date: 
Account #_____                                        www.ibervilleparish com.                                            (FOR OFFICE USE ONLy) 
(Do Not use any other taxpayer's return as this may result in improper credit.)        Tax Report for the Period             _______ 

                                                                                    Col. A (5.000%)         Col.      8 (5.666%)       Col. D(7.666%) 
                                                                                       Parishwide           City of St. Gabriel        UCC  Economic 
                                                                                       excluding                   Corporate     Dev   . Dist. Sl Gabriel 
                                                                                   City of St. Gabriel             Limits only         Corp. Limits' 

                                                                                               HAVE YOU     USED THE PROPER      COLUMN? 

                                                                                Number for Contact Person
Parish Account Number                        State Tax ID Number 

                                                                                       • 1::r!l:I~I~I'HIf·••::It'· u,   .      :1::111 
                                                                        DFINAL II Date business closed                  Date business  sold 
                                                                        RETURN 
                                                                        Name    of New Owner 

                                                                        Mailing address change 

                                                                        Location address change 

                                                                                                                                                Rev. 10122