Office Use Only 
St. John the Baptist Parish                                                                               Sales Tax Acct:  
                                                                                                          Occ Lic Acct: 
Application for Occupational License and Sales Tax Registration
Reason for Applying:  
□ New Business    □ Purchased Existing Business   □  Opening Additional Location  □ Merger     □                  □ Name Change

Previous Name: ___________________________________________________    Previous Account No.:  _____________________________________
Legal Name                                                        Trade Name

Contact Name/Title                                                Telephone No                   Email Address 

Business Type:                                                                                                          Federal ID No.

□ Sole Proprietor            □ Corporation □             Limited Liability Company □ Professional Partnership
                                                                                                                        Louisiana Sales Tax No
□ Non-Profit (attach IRS designation)      □ Other:________________________________________________
Nature of Business                                                                                        Transactions to Occur

□ Retail     □ Wholesale       □ Service   □ Manufacturer         □ Contractor       □ Peddler            □ State Wide          □ Parish Wide

□ Restaurant/Food Service      □ Beer  Only □ Beer & Liquor □ Other: _____________________                □ Other: _____________________ 
NAICS CODE            Description of Business Activities 

Business Location: = Check One *attach copy of lease   ** ‐ attach copy of lease & owner authorization for use of property for business name & type 

□ Applicant Owned □ Leased property *      □ Home‐based ‐Applicant Owned           □ Home‐based‐Not Owned by Applicant** 
Physical (Business) Address: 

City                                         State                Zip Code                       District (If located in St John the Baptist Parish)

Mailing Address: 

City                                                        State Zip Code                               Website 

Name and Address for Louisiana Agent for Service or Process       Location of Accounting Records                                                    Describ

Name of Manager or Operator                Telephone Number                          Driver’s License No  Email Address                             Descrip

Name (Sole Proprietor’s Only)                               Date of Birth            Social Security Number       Driver’s License No.

Address                                                     City                     State       Zip Code         Phone Number

Organizational Officers, Members, Managers 
Name                                                        Title                  Date of Birth         Social Security Number Driver’s License No.

Home Address                                                City                     State               Zip Code Phone Number

Name                                                        Title                  Date of Birth         Social Security Number Driver’s License No.

Home Address                                                City                     State               Zip Code Phone Number

 I here acknowledge that I have been advised of the following:  sales taxes become delinquent on the 20  day of the month when due; th
 occupational licenses become delinquent on March 1  of the year that taxes are due; business owners and certain officers, members and st
 managers may be held responsible for taxes not paid in accordance with the ordinances, laws, and regulations; and are further required 
 to keep, preserve, and make available for inspection suitable records of sales, purchases, leases, or other revenue sources subject to 
 sales, use, or occupational license taxes  to determine the amount of such tax as may be due and must do so until such taxes have 
 prescribed.  
  
 __________________________________________________    _______________________________________ 
 Applicant Signature                                                                                                                                       Date
                                                                        FOR OFFICE USE ONLY
 Parish Administration, Planning & Zoning Department 

 □ Approval Compliance Form            Authorized by:  ________________________________________  Date:  _______________________ 
 Utilities Department Waste Water Application 

 □ Approved Form Attached               Authorized by:  ________________________________________  Date:  _______________________ 
 Office of State Fire Marshal 

 □ Approved NoticeAttached              Authorized by:  _________________________________________  Date:  ______________________
 Louisiana Department of Health  (If Required) 

 □ Approved NoticeAttached              Authorized by:  _________________________________________  Date:  ______________________
 Site Plan for Fireworks Stand (If Required) 

 □ Approval Letter Attached                Authorized by:  ________________________________________  Date:  _______________________
 Sheriff’s Office‐Application for Retail Alcoholic Beverage Permit (If Required)

 □ Approved Application Attached   Authorized by:  ________________________________________  Date: ________________________
 Sheriff’s Office—Schedule A for Each 5% Member/Shareholder (If Required)

 □ Approved Schedule(s) Attached   Authorized by:  ________________________________________  Date: ________________________
 Sheriff’s Office—Schedule F for Each Member/Shareholder (If Applicable)

 □ Approved Schedule(s) Attached  Authorized by:  _________________________________________  Date: ________________________
 Sheriff’s Office—Schedule R Restaurant Permit (If Required) 

 □ Approved ScheduleAttached       Authorized by:  _________________________________________  Date: ________________________
                                             ‐‐Use Section Below If Applying For Occupational License Only‐‐ 
                                                                                Affidavit 
 I, __________________________________________________, have applied for an occupational license to the Office of the Parish 
 President of St. John the Baptist Parish for a business that will bear the name of: 
  
 ___________________________________________________________________________________________, and will be located at 
 ____________________________________________, ___________________, LA  __________
 Street Address                                                                                                                                                  City                                                                                 Zip Code
 Business activities, which will be located at the above address, in the name of said business, will be as follows: 
 _____________________________________________________________________
 _____________________________________________________________________ 
 I hereby acknowledge under oath that the above information given is true to the best of my knowledge, and that this will be the only 
 business activity at the above location.  I also hereby acknowledge under oath that the business activity that will be conducted at the above 
 location is in full compliance with all Ordinances of St. John the Baptist Parish, and both State and Federal Laws. 
  
 _________________________________________________      ___________________________________ 
 Signature of Applicant                                                                                                                                  Date
  
 SWORN TO AND SUBSCRIBED BEFORE ME THIS ______________ DAY OF ________________________, 20______ 
  
                                                                                                             ____________________________________________ 
                                                                                                                                                                   Notary Public