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                                           Zip Code             District                       
                                                                                                    
 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 (attach additional sheets if necessary) 
 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 thday of the month when due; 
 occupational licenses become delinquent on March 1 stof the year that taxes are due; business owners and certain officers, members and 
 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 
                                --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