Jefferson Parish Sheriff's Office
    Bureau of Revenue and Taxation                                    Sales Tax                         Account No.
     Sales Tax Division
    P. O. Box 248, Gretna, LA 70054                                 Delinquent on the 20th              Location
                                                                                                        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
                                                                                                                                  State Tax Identification Number
                                                                           Important - Use this form for the period and 
                                                                           location shown above. Use black or blue ink and 
                                                                           keep print in the boxes.  You must submit an 
                                                                           original return, photocopies will not be accepted.      Amended Return
                                                                           To avoid penalty and interest, return this form with    Fill Circle
                                                                           remittance no later than the 20th of the month 
                                                                           following the reporting period.                         Business Closed
                                                                           For assistance call 504-363-5710.                       Attach letter showing date.
01    Gross Sales of Tangible Personal Property, Leases, Rentals and Services  (See instructions on Reverse Side)               01
                                                                      Sales for Resale                                          02
                                                       A          D   Cash Discounts: Returned Merchandise                      03
                                                       L          E
                                                       L          D   Sales Delivered Outside this Jurisdiction                 04
                                                       O          U   Sales of Gasoline and Motor Fuels                         05
                                                       W C
                                                       A          T   Sales to Government Agencies                              06
                                                       B          I   USDA Food Stamps or WIC Vouchers                          07
                                                       L          O
                                                       E          N   Other Deductions Allowed by Law (Itemize)                 08
                                                                  S
     Make checks payable to                                                                                                     09
    SHERIFF AND TAX COLLECTOR,
     JEFFERSON PARISH                                                                                                           10
11    Total Allowable Deductions (Line 2 thru Line 10)                                                                          11
12    Adjusted Gross Sales (Line 1 minus Line 11)                                                                               12
13    Taxable Sales                                                                                                                4.75 % General Sales
                                                                                                                                13
14    Purchases Subject To Use Tax                                                                                              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
17    Excess Tax Collected                                                                                                      17
18    Total (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% for each 30 Days or Fraction thereof not to exceed 25%)                                                       21
22    Interest (1% from due date until paid)                                                                                    22
23    Total Tax, Penalty, and Interest Due (Line 20 thru Line 22)                                                               23
24    Tax Debit or Credit  (Authorized Memo Must Be Attached)                                                                   24
25    Total (Line 23 plus or minus Line 24)                                                                                     25
26    Total to be Remitted (Same as Line 25)                                                                                    26

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 the information 
relating to the matters required to be reported in the return of which he has any knowledge.

Date                                         Signature                                      Title                              Preparer Signature

Form
    0001                  R