Direct all mail and payments to:  
  
 Plaquemines Parish                                    Plaquemines Parish Government 
 Sales Tax Division                                    Plaquemines Parish School Board 
 333 F. Edward Hebert Blvd 
 Building 102, Suite 345                                    SALES AND USE TAX 
 Belle Chasse, LA 70037                              HOTEL/MOTEL OCCUPANCY TAX 
                                                                                                 
 Thisstreturn DUE on the                                                                      
    1  day of month 
 following period covered                                   
    by the return and                                                                                      Month:                            Year: 
 becomes DELINQUENT 
    on the 21 stday.                                                                          
                                                 PLEASE INDICATE ANY CHANGES BELOW 
Date Business Discontinued                                       Date Business Sold                          Name of Purchaser 
                                                                                                              
Business Location Change                                           Mailing Address Change 
                                                                                                              
Type (Ind, Corp, LLC, LLP, etc.)                                 Other                                       Signature and Title of Preparer 

       ELECTRONIC FILING AVAILABLE AT WWW.PARISHE-FILE.REVENUE.LOUISIANA.GOV 
               
1. GROSS SALE OF TANGIBLE PERSONAL PROPERTY LEASES, RENTALS, AND                                        1.                      **NOTICE** 
SERVICES AS REPORTED TO THE STATE OF LOUISIANA 
                                 ALLOWABLE DEDUCTIONS                                                                             
2. SALES FOR RESALE                                                                        2.                     COLUMN A = Line 8 plus 
3. CASH DISCOUNT; SALES RETURNS AND ALLOWANCES                                             3.                                    Line 9 
4. SALES DELIVERED OR SHIPPED OUTSIDE THIS JURISDICTION                                    4.                                     
5. SALES OF GASOLINE AND MOTOR FUELS                                                       5.                                   COLUMN B = Line 12 
6. SALES TO U.S. GOVERNMENT, STATE OF LA, AND ITS POLITICAL SUBDIVISIONS                   6.                                     
7. SALES OF FOOD PAID FOR WITH USDA FOOD STAMPS OR WIC VOUCHERS                            7.                     COLUMN C = Gross Sales 
8. SALES OF FOOD AND DRUGS                                                                 8.                                   From Room Rentals 
9. SALES OF EQUIPMENT TO COMMERCIAL FISHERMAN                                              9.                                     
              OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)                                                              **NOTICE** 
10.                                                                                        10.                 
                                                                                             
11. TOTAL ALLOWABLE DEDUCTIONS (LINES 2 THRU 10)                                           11.                 
12. ADJUSTED GROSS SALES (LINE 1 MINUS 11)                                                 12.                 
                                                                                             
                                                                                                              SALES AND USE TAX  OCCUPANCY TAX 
                                                                                                                                                                                                                        
                          COMPUTATION OF TAXES 
                                                                                                COL A - 3.5%   COL B - 4.5%                  COL C – 2% 
13. TAXABLE SALES                                                                          13.                                                                                                                            
14. PURCHASE SUBJECT TO USE TAX                                                            14.                                                                                                                          
15. TOTAL (Line 13 plus line 14)                                                           15.                                                                                                                            
16. TAX DUE (Multiply line 15 by % shown in column)                                        16.                                                                                                                            
17. EXCESS TAX COLLECTED                                                                   17.                                                                                                                            
18. TOTAL (Line 16 plus Line 17)                                                           18.                                                                                                                            
19. VENDOR’S COMP (0.935% of line 18, not to exceed $1,500 – deductible only when payment  19.                                                                                                                            
is not delinquent 
20. NET TAX DUE (Line 18 minus line 19)                                                    20.                                                                                                                            
21. DELINQUENT PENALTY (5% of tax for each 30 days or fraction thereof of delinquency, not 21.                                                                                                                            
to exceed 25% in the aggregate) 
22. INTEREST 12% PER ANNUM                                                                 22.                                                                                                                            
23. TOTAL TAX, PENALTY, & INTEREST DUE                                                     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 (Column A plus Column B plus Column C)                           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 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 20 THDAY FOLLOWING PERIOD COVERED                                                                                                                  
DATE                               SIGN HERE                       SIGNATURE OF PREPARER OTHER THAN TAX PAYER                   REVIEWED BY