St. Bernard Sheriff's Sales & Use Tax Return 
PARISH OF ST. BERNARD                                 This form is designed for Adobe Acrobat Reader V8.x & later.  Prior versions may produce unexpected results. 
SALES AND USE TAX DEPARTMENT                          Once you complete the form, you should print the form and send it to the address shown on the form. 
              P.O. Box 168                                                                                                           Click here to download the latest version of Adobe Reader 
              Chalmette, LA  70044                    Click in Account# Field to Start. RED blocks indicate Required Information Needed!  

Account#                                                                 DO NOT use any other taxpayer's return                                                             Reset Form
                                                      WARNING:                                                                                                              Print Form
                                                                         as this will result in improper credit

                                 Business Name                                                                                       Make Checks Payable to:
                                 Mailing Address                                                                                        JAMES POHLMANN 
                                                                                                                                     Sheriff and Tax Collector
                                 City                                     State                                    LA Zip
                                          Phone
TO AVOID PENALTIES RETURN 
MUST BE TRANSMITTED ON OR                 Location
BEFORE THE 20  DAY FOLLOWING TH
                                                                                                                                     Signature of owner officer or agent
THE PERIOD COVERED
SALES AND USE TAX DEPARTMENT 
              504-271-2504 
SALES AND USE TAX RETURN

Filing Period                         Year                                                                                           Signature of preparer other than taxpayer
                                                                                                                                     Enter Date or Use Arrow to Open Calendar
1.            GROSS SALES OF TANGIBLE PERSONAL PROPERTY  
2.            LEASES, RENTALS, AND SERVICES  
3.            COST OF TANGIBLE PERSONAL PROP(Used, consumed, stored for, use or consumption in ST. BERNARD PARISH)  
4.            TOTAL OF ITEMS 1,2 AND 3  
                                                      ALLOWABLE DEDUCTIONS
5.  A.        SALES FOR RESALE
   B. SALES OUTSIDE OF ST. BERNARD PARISH
   C. SALES FOR FURTHER MANUFACTURE
   D. SALES TO THE UNITED STATES GOVERNMENT
   E. CASH DISCOUNTS, SALES RETURNS AND ALLOWANCES
   F. SALES IN INTERSTATE COMMERCE
   G. FERTILIZER, INSECTICIDES, FUNGICIDES, PESTICIDES,AND 
              SEED SOLD DIRECT TO FARMERS
   H. SALES OF GASOLINE (Special fuels if 20 cent road tax has been paid)
    I. ANY OTHER DEDUCTIONS AUTHORIZED BY LAW (Itemize)
    J. TOTAL ALLOWABLE DEDUCTIONS (Enter at item 6)
6.            LESS ALLOWABLE DEDUCTIONS (Item 5A through I)
7.            AMOUNT TAXABLE (Item 4 minus Item 6)  
8.            Tax:  5.00% of Item 7  
9.            EXCESS TAX COLLECTED  
10.           TOTAL (Item 8 plus Item 9)  
11.           VENDOR'S COMPENSATION (Check box if eligible for Vendor's Comp. (1.5%). Must be Filed by 20th following period covered)
12.           AMOUNT TAX DUE (Item 10 minus Item 11)  
13.           TAX DEBIT OR CREDIT (Authorized memo must be attached)  
14.           DELINQUENT PENALTY 
              (5% of Tax for each 30 days or fraction thereof of delinquency, not to exceed 25% of the aggregate)  
15.           INTEREST: (15% per annum from due date until paid)  
16.           TOTAL TAX, PENALTY AND INTEREST DUE ----------------------------------------------------------------------------------------------------------->
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 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.
Printed on:   2012-07-25 12:40:59

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                                                                                                                                     Version: SBSO STax V.1-2012-001        Print Form