OCCUPATIONAL LICENSE TAX APPLICATION 
       (The tax is due January 1 for existing businesses, and is delinquent after the last day of February.) 
 
1. Date of Return ____/____/____ (MONTH ,DAY ,YEAR) 
2.   New Business   Renewal--PROVIDE PRIOR YEAR’S LICENSE NUMBER:______________ 
3. FEDERAL EMPLOYER ID NUMBER:  _________________________    
4. LA SALES TAX NUMBER:    _________________________    
5. LOCAL SALES TAX NUMBER: _________________________ 
6A.TAXPAYER NAME        B.TELEPHONE NUMBER  
 __________________________________________________________________________  
C. TRADE NAME 
   _________________________________________________________________________________________ 
D. MAILING ADDRESS, CITY, STATE, ZIP CODE  
 __________________________________________________________________________ 
E. PHYSICAL LOCATION, STREET ADDRESS, CITY, STATE, ZIP CODE   
 _________________________________________________________________________________________ 
7. Location of Accounting Records:      “     d  “ e 
 
8. Type of Business:  “    Individual     “ Partnership     “Corporation     
     “ Governmental    “ Non-profit   “ other  (specify)_______________ 
 
9. Provide information on owner(s) below. If corporation or partnership,         
      provide information for officers or partners. For corporation, 
      provide state of incorporation:  
 
 NAME TITLE                                              SOCIAL SECURITY NUMBER                               
                                               
 RESIDENT ADDRESS                                        TELEPHONE NUMBER 
  
 NAME TITLE                                              SOCIAL SECURITY NUMBER                               
                                               
 RESIDENT ADDRESS                                        TELEPHONE NUMBER 
  
 NAME TITLE                                              SOCIAL SECURITY NUMBER                               
                                               
 RESIDENT ADDRESS                                        TELEPHONE NUMBER 
  
10. Name and address of agent for service of process 
________________________________________________________________________________ 
 
11. Nature of Business-description of sales or activity. 
 
I affirm that the information given on this application and the attached 
schedules is true and correct. 
 
12.  SIGNATURE OF APPLICANT____________________________ TITLE________________ 
  
SIGNATURE OF PREPARER IF DIFFERENT FROM ABOVE______________________________________ 
                                              

                            SCHEDULE A:  CALCULATION OF TAXABLE GROSS         RECEIPTS 
        
       NEW BUSINESS  
        
       13. C   HECK ONE: 
            “STARTED NEW BUSINESS ON ______________(DATE) 
            “PURCHASED EXISTING BUSINESS–NAME OF PREVIOUS OWNER       ____________________________ 
            “OTHER(SPECIFY     )_________________________________________________________ 
        
       14. C  HECK ONE BOX BELOW AND FOLLOW INSTRUCTIONS TO CALCULATE TAXABLE GROSS RECEIPTS: 
        
       “BUSINESS OPENED THIS CALENDAR YEAR 
        
            LESS THAN    30 DAYS 
                      “BETWEEN DECEMBER  2AND DECEMBER           31;  
                              TOTAL GROSS RECEIPTS FOR PERIOD OF OPERATION:                _____________
                      “PRIOR TO DECEMBER     2; PAY MINIMUM TAX ;CALCULATE REMAINDER DUE  
                             AFTER FIRST 30 DAYS OF OPERATION USING METHOD IMMEDIATELY BELOW. 
            “MORE THAN 30 DAYS; 
                      A .GROSS RECEIPTS FOR FIRST       30 DAYS  :    ___________ 
          .B  DEDUCTIONS*:_______________                             ___________ 
          .C  A MINUS B EQUALS TAXABLE RECEIPTS:                      ___________
          .D  NUMBER OF MONTHS IN OPERATION:                                  ____ 
                   E .D TIMES C EQUALS ESTIMATED TAXABLE GROSS OF     :                    ___________ 
        
       “BUSINESS OPENED DURING THE PREVIOUS CALENDAR YEAR 
        
                      A .GROSS RECEIPTS:                              _____________
                      B .DEDUCTIONS   *:_________________             _____________ 
         C .A MINUS B EQUALS TAXABLE RECEIPTS                    :    _____________
         D .NO .OF DAYS OPERATION               :                             _____ 
         E .C/D EQUALS AVERAGE GROSS RECEIPTS                    :    _____________
                      F  . 365 TIMES E EQUALS ESTIMATED TAXABLEE GROSS OF:                 _____________ 
        
       “EXISTING BUSINESS 
        
       15.            A .GROSS SALES/RECEIPTS:                        _____________
                      B .DEDUCTIONS   *:______________                _____________ 
                      C .A MINUS B EQUALS TAXABLE RECEIPTS       :                         _____________ 
        
       “RETAIL DEALERS OF GASOLINE AND MOTOR FUELS              
        
       16.            A .GROSS SALES/RECEIPTS   :    _____________ 
                    (DO NOT INCLUDE SALES OF MOTOR FUELS)     
                      B. DEDUCTIONS*:__________________               _____________ 
                      C.   AMINUS   B EQUALS TAXABLE  ECEIPTSR :      _____________ 
                      D. TAX DUE FROM TABLE 1                         _____________ 
                      E. GALLONS OF GASOLINE & MOTOR FUELS SOLD _____________ 
                      F. TAX DUE ON LINE E FROM TABLE 1.1             _____________ 
                      G. TOTAL TAX DUE LINE D PLUS LINE F             _____________ 
                 H. MAXIMUM TAX DUE                                   _____6,200.00 
                 I. ENTER THE LESSER OF LINE G or LINE H                                  ______________ 

17.  CLASS    : “ RETAIL  “ WHOLESALE    “ COMMISSION     PUBLIC“ UTILITIES     LENDING  “       
       OTHER“  
 
18. U  SE APPROPRIATE TABLE TO CALCULATE TAX DUE:
     (FOR OTHERS ,PROFESSIONALS ,OR PHARMACIES MULTIPLY TAXABLE RECEIPTS BY .1%)  ______________
 
19. F  LAT FEES: 
ITEM N F TI                 UMBER                       EE                       OTAL FOR  TEM   

 T OTAL FOR FLAT FEES
 
20.  AMOUNT OF TAX DUE (TOTAL OF LINES   18 AND 19)                              _______________
 
21. I  NTEREST (1¼% PER MONTH OF THE TAX DUE FROM THE DUE DATE UNTIL   
     UNTIL TAX IS PAID):                                                   _______________       
                                                                                                        
22.  ENALTYP  (5%  OF THE TAX DUE FOR EACH THIRTY DAYS ,OR FRACTION          
     THEREOF ,FROM THE DUE DATE UNTIL THE RETURN IS FILED ,BUT IS LIMITED         
     TO A TOTAL OF 25%):                                                         _______________
 
23.  TOTAL AMOUNT DUE                                                            _______________  
 
*DEDUCTIONS ARE ALLOWABLE FOR THESE BUSINESSES :SERVICE STATIONS ,          INTERSTATE SALES OF STOCKS 
& BONDS ,AND UNDERTAKERS  .