Jefferson Parish Sheriff’s Office
JOSEPH P. LOPINTO, III                                                   Bureau of Revenue and Taxation 
SHERIFF AND EX-OFFICIO TAX COLLECTOR                                     P.O. Box 248 
Telephone:     (504) 376-2459                                            Gretna, Louisiana 70054-0248 
Facsimile:     (504) 376-2469  

               APPLICATION FOR JEFFERSON PARISH MANUFACTURER’S EXCLUSIONCERTIFICATE 

SECTION 1:  OWNERSHIP INFORMATION                                           DATE OF APPLICATION:                                        /    / 
Federal Taxpayer ID Number                              LA Sales Tax Number                              Jefferson  Parish License/Sales Tax Number

Taxpayer Name / Corporate Name                                              Trade Name 

Plant Facility Location (Include City, State, Zip Code)                                                  Telephone – Plant Facility Location 

Mailing Address (Include City, State, Zip Code)                                                          Telephone – Mailing Address 

Contact Person                                          Email Address                                    Telephone Number 

SECTION 2:  BUSINESS INFORMATION 
(1) Has this business been issued a Manufacturer’s Exemption or Exclusion Certificate by the LA Department of Revenue?                   YES                     NO 
 If yes, attach copy of certificate. 

 (2)  Business Activity Code Number (NAICS) listed on the most recently filed federal income tax return: 
Business Activity Code:                                                   Year of form submitted: 
SECTION 3:  BUSINESS DESCRIPTION 
Manufacturing means putting raw materials through a series of steps that brings about a change in their composition or physical nature in order to 
make a new and different item of tangible personal property that will be sold to another.   
(1) Description of actual manufacturing process at the plant facility location listed above: (Attach additional sheet(s) if necessary.) 
_________________________________________________________________________________________________________________________ 
_________________________________________________________________________________________________________________________ 
_________________________________________________________________________________________________________________________ 
(2) What is the principal business activity of the applicant? [The manufacturing exclusion may only be claimed by a business that actually engages in 
manufacturing as its principal business activity - it is NOT SUFFICIENT merely to qualify for a manufacturing Business Activity Code Number]:  

_________________________________________________________________________________________________________________________ 
_________________________________________________________________________________________________________________________ 
(3) Products (tangible personal property) manufactured by the business:  

_________________________________________________________________________________________________________________________ 
_________________________________________________________________________________________________________________________ 
(4) Percentage of total sales of the business directly attributable to manufacturing tangible personal property for sale: ____________________________ 
I affirm the information given in this application and any supporting documents are true and correct.  I further acknowledge that I have read and understand the 
provisions of this exclusion as provided on the reverse side of this application.  I understand and acknowledge that: the Manufacturer’s Exclusion Certificate 
does not relieve or release the holder of the certificate from any liability for sales and use taxes due on transactions which are not in fact eligible for the 
exclusion; and the fact that a vendor relies on the certificate by not collecting sales and use taxes from the holder of the certificate has no bearing or affect 
whatsoever on the liability of the holder of the certificate for sales and use taxes due on transactions which are not in fact eligible for the exclusion. 

               Printed name of applicant                                                                  Title 

               Signature of applicant                                                                     Date 

                               Instructions for the Jefferson Parish Manufacturer’s Exclusion Application 

The Jefferson Parish Code of Ordinances Section 35-71 provides that eligible manufacturers may qualify for an exemption from sales/use tax 
on the cost price of qualified manufacturing machinery or equipment used by a manufacturer in a plant facility predominately and directly in the 
actual manufacturing for agricultural purposes or the actual manufacturing process of an item of tangible personal property, which is for 
ultimate sale to another and not for internal use, at one (1) or more fixed locations within Jefferson Parish, the cost price shall be reduced by 
one hundred (100) percent beginning January 1, 2006. 

Part 1 – Ownership Information 
Legal Name – Enter the legal name of the business for corporations and limited liability companies, the individual owner’s name for sole proprietorships, or the 
names of the principal partners for partnerships. 
Sales Tax Number – Enter the LA Sales Tax Account Number and the Jefferson Parish Tax Account Number.  Note: Businesses must have a Jefferson Parish 
Tax Account Number prior to submission of this application.  Applications for sales tax registration are available at www.jpso.com (see Revenue and Taxation). 
Trade Name – Enter the trade name of the business if different from the legal name(s). Otherwise, write “Same.” 
Plant Facility Address – Enter the physical location where the business is located (street number or name). Do not enter a post office box number on this line. 
City, State, ZIP – Enter the city, state, and zip code for the plant facility address. 
Mailing Address – Enter the mailing address for the exclusion certificate if different from the location address. If the mailing address is the same as 
the location address, write “Same.” 
City, State, ZIP – Enter the city, state, and zip code for the mailing address. 
Contact Person   – Enter the name of the person that can respond to questions regarding this application. 
Email Address – Enter the email address of the contact person. 
Telephone Number – Enter the telephone number (including area code) where the contact person can be reached during normal business hours. 
Part 2 – Business Information 
You must attach a copy of the Manufacturer’s Exemption Certificate issued by the LA Department of Revenue. 
Part 3 – Business Description 
Provide a complete description of the manufacturing process performed at the plant facility location in Jefferson Parish and the customers of the product 
manufactured.  Incomplete descriptions will result in a denial of your application. 
Provide a description of the type of finished goods produced and its anticipated uses. 
Provide the percentage of total sales of the business directly attributable to manufacturing tangible personal property for sale. 
Please submit the completed application to the Jefferson Parish Sheriff’s Office, Bureau of Revenue and Taxation, P.O. Box 248, Gretna, LA 70054.