1.  Gross Sales of tangible property.  Leases, rentals and Services as reported to the 
State of Louisiana.
                                 ALLOWABLE DEDUCTIONS
2.  Sales For Resale
3.  Cash Discounts, Sales Returns, and Allowances
4.  Sales Delivered or shipped Outside This Jurisdiction                                                                                 City of Monroe
5.  Sales of Gasoline and Motor Fuels                                                                                           Taxation and Revenue Division
6.  Sales to agencies of the U.S. Govt., the State of LA., and it political subdivisions                                                 PO BOX 123
7.  Sales of food paid for with USDA Food Stamps or WIC Vouchers                                                                         MONROE, LA 71210-0123
   OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)
8.
9.
10.
11.  TOTAL ALLOWABLE DEDUCTIONS (Lines 2 through 10)
12.  ADJUSTED GROSS SALES (Line 1 minus Line 11)                                                                                TO AVOID PENALTIES, RETURNS MUST BE TRANSMITTED ON OR BEFORE THE 20TH DAY FOLLOWING THE PERIOD COVERED.
                                                                                         Column 1               Column 4        Column 2 Column 7        Column S    Column 3      Column R           Column 8                         Column 9
                                                                                         City of Monroe            East         City of  West            Town of     City of       City of            City of West                     Town of 
   COMPUTATION OF SALES AND USE TAX                                                      Prescrip. Drug & Foods Ouachita Parish Monroe   Ouachita Parish Sterlington   West Monroe Richwood           Monroe EDD                       Sterlington EDD
                                                                                              4.99%             5.99%           5.99%    5.99%           6.50%       5.99%         5.50%              6.99%                            8.50%
13.  Adjusted Gross Sales FROM LINE 12 FOR Each Jurisdiction
14.  Purchases Subject To Use Tax In Each Jurisdiction
15.  TOTAL (Line 13 plus line 14)
16.  TAX (Line 15 times applicable %)
17.  Excess Tax Collected
18.  TOTAL (Line 16 plus line 17)
19. Vendor's Compensation (1% of line 18 deductible only when payment is not delinquent)
20.  NET TAX DUE (Line 18 minus line 19)
21.  Delinquent Penalty (5% of tax for each 30 days or fraction thereof of 
delinquency, not to exceed 25% in the aggregate)
22.  INTEREST 15% per annum / 1.25% per month or a fraction thereof
23.  TOTAL TAX, PENALTY, AND INTEREST DUE
24. Tax Debit or Credit (Authorized Memo Must Be Attached)
25.  TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)
26. Remittance Attached  

                                                                                         Signature of Taxpayer                           Signature of Preparer other than Taxpayer
I declare under penalties for filing false reports that this return and attachments has 
been examined by me and to the best of my knowledge & belief is a correct and 
complete return.  If prepared by a person other than the taxpayer, his/her declaration 
is based on all information relating to matters required to be reported in the return of Date                   Reviewed By              Contact Phone #         State Sales Tax Identification Number
which he/she is knowledgeable.

                                                          MONTH ENDING                                                                   Final Return
   WARNING!                                                                                                                                          Make Remittance Payable To:
   DO NOT USE ANY OTHER TAX-                              ACCOUNT NO.:                                                                               TAXATION AND REVENUE DIVISION
   PAYERS RETURN AS THIS WILL                                                                                                                        P.O. BOX 123
   RESULT IN IMPROPER CREDIT                              ACCOUNT NAME:                                                                              Monroe, Louisiana  71210-0123