RED RIVER PARISH
                                                    SCHOOL BOARD
                                                    SHERIFF'S OFFICE
                                                    POLICE JURY
                                                    AMBULANCE

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COMPUTATION OF SALES AND       TOTAL RATE           4½%            5½%                            5½%
USE TAX                                   SCHOOL BOARD,     TOWN OF COUSHATTA,            VILLAGE OF HALL
                                          POLICE JURY,      SCHOOL BOARD,                 SUMMIT SCHOOL
COMPLETE ONLY THOSE COLUMNS IN            SHERIFF'S OFFICE, SHERIFF'S OFFICE, POLICE JURY,SHERIFF'S OFFICE,BOARD, POLICE JURY,
WHICH TAXABLE ACTIVITY OCCURS             & AMBULANCE       & AMBULANCE                   & AMBULANCE

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                                                    RED RIVER PARISH
                                                    SCHOOL BOARD
SALES TAX DEPARTMENT                                SHERIFF'S OFFICE
RED RIVER TAX AGENCY                                POLICE JURY
P. O. BOX 570                                       AMBULANCE
COUSHATTA, LA 71019
PH. 318-932-1817

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COMPUTATION OF SALES AND       TOTAL RATE           4½%           5½%                                         5½%
USE TAX                                   SCHOOL BOARD,    TOWN OF COUSHATTA,                         VILLAGE OF HALL
                                                                                                      SUMMIT SCHOOL
                                          SHERIFF'S OFFICE,
COMPLETE ONLY THOSE COLUMNS IN            POLICE JURY,     SHERIFF'S OFFICE, SCHOOL BOARD,POLICE JURY,SHERIFF'S OFFICE,BOARD, POLICE JURY,
WHICH TAXABLE ACTIVITY OCCURS             & AMBULANCE      & AMBULANCE                                & AMBULANCE

(LINE 13 PLUS LINE 14)

                                          TAXPAYER'S COPY

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                                                               CHANGE OF OWNERSHIP OR ADDRESS
                                                           DATE BUSINESS DISCONTINUED                                                     DATE BUSINESS SOLD

                                                           NAME OF PURCHASER

                                                           MAILING ADDRESS CHANGE

                                                           CHANGE IN NAME OF BUSINESS

                                                           SIGNATURE AND TITLE OF PREPARER