Jefferson Parish Sheriff's Office Account No.
Bureau of Revenue and Taxation Sales Tax
Sales Tax Division Location
P. O. Box 248, Gretna, LA 70054 Delinquent after the 20th
Address
Year: Year of Collection
Filing: M = Month Period: 01-12
Business Name and Mailing Address Q = Quarter Period: 01-04
S = Semi-Annual Period: 01-02 Year Filing Period
Important - Use this form for the
period and location shown above. Use State Tax Identification Number
boxes. You must submit an original return,
black or blue ink and keep print in the
photocopies will not be accepted. To avoid
penalty and interest, return this form with Amended Return
remittance no later than the 20th of the Fill Circle
month following the reporting period.
For assistance, call 504-363-5710. Business Closed
Attach letter showing date
01 Gross Sales of Tangible Personal Property, Leases, Rentals and Services 01
Allowable Deductions **NOTICE**
02 Sales for Resale or Further Processing (Valid resale certificates on file) 02
03 Cash Discounts, Returned Merchandise 03
COLUMN A: Taxable Sales In The Corporate
04 Sales Delivered or Shipped Outside Jefferson Parish (Not applied to repairs) 04 Limits Of The City Of Harahan
05 Sales of Gasoline and Motor Fuels 05
COLUMN B: Taxable Sales In The North 1300
06 Sales to U.S. Government, State of Louisiana and its Political Subdivisions 06
Veterans Boulevard Economic
07 Sales of Food Paid for with USDA Food Stamps or WIC Vouchers 07 Development District
Other Deductions Allowed by Law
(excluding local optional exemptions/exclusions listed on reverse side) COLUMN C: Taxable Sales In All Other Areas
08 Describe: 08 Of Jefferson Parish
09 Describe: 09
10 Describe: 10 Make checks payable to:
11 Total Allowable Deductions (Add Line 2 through Line 10) 11 SHERIFF AND TAX COLLECTOR,
JEFFERSON PARISH
12 Adjusted Gross Sales (Line 1 minus Line 11) 12
A B C
Computation of Taxes City of Harahan N 1300 Vet. Blvd. EDD All Other Areas
Taxable Sales Taxable Sales Taxable Sales
5.55% 6.75% 4.75%
13 Adjusted Gross Sales in Each Jurisdiction (Total of all columns must equal Line 12) 13
14 Purchases Subject to Use Tax in Each Jurisdiction 14
15 Total Subject to Tax (Line 13 plus Line 14) 15
16 Tax Calculations (Multiply Line 15 by % shown at top of Column) 16
16a Reduced Rate Reductions per Schedule A on Reverse Side of Form 16a
16b Net Tax Due (Line 16 minus Line 16a) 16b
17 Excess Tax Collected (Tax collected in excess of Line 16b) 17
18 Total Tax Due (Line 16 plus Line 17) 18
19 Vendor's Compensation (1% of Line 18, Deductible if not delinquent) 19
20 Net Tax Due (Line 18 minus Line 19) 20
21 Penalty (5% of tax for each 30 days or fraction thereof, 25% maximum) 21
22 Interest (1% from due date until paid) 22
23 Total Tax, Penalty and Interest Due (Add Line 20 through Line 22) 23
24 Tax Debit or Credit (Authorized memo must be attached) 24
25 Total Amount Due (Line 23 plus or minus Line 24) 25
26 Total Amount Remitted (Total of Line 25 Columns A, B and C) 26 Check Number:
I declare under the penalties for filing false reports that this return (including any accompanying schedules and statements) has been examined by 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, his declaration is based on all information relating to the matters required to be reported in the return of which he has any knowledge.
TO AVOID PENALTIES RETURN SHOULD BE TRANSMITTED ON OR BEFORE THE 20TH DAY FOLLOWING THE PERIOD COVERED
Date Signature Title Signature of Preparer if Other Than Taxpayer
Form 0111 Effective 08/01/2023 Page 1