Month:                                      Account #:                            Bus. Name:
1 Gross sales of tangible personal property, leases, rentals and services 
    as reported to the State of Louisiana
                              ALLOWABLE DEDUCTIONS
2 Sales for resale                                                                                                                Business Closed     Date Closed:
3 Cash discounts, sales returns and allowances                                                                                      Comments
4 Sales delivered or shipped outside of Vermilion Parish
5 Sales of gasoline and motor fuels
6 Sales to U.S. Govt. and State of Louisiana
    Other deductions authorized by law (explain briefly)
7/8
9/10
11 Total allowable deductions (lines 2 thru 10)
                                                                                                State ID#:                        Signature:
12 Adjusted Gross Sales (line 1 minus line 11)

Notes:                        A                          A1               A2      B             C                 D                         E         F                     G
Report all Hotel/Motel      School Board       Hospital Dist #1 Hospital Dist #2  Gueydan       Kaplan            Abbeville                 Erath     Delcambre             Maurice  
sales in column H on          Police Jury      Parish &         Parish &          &             Parish &          Parish &          Parish &          Parish &          Parish &  
separate Hotel/Motel Tax    Sheriff’s Dept.    Outside Kaplan   Outside Abbeville  Parish   Hospital Dist. #1     Hospital Dist. #2 Hospital Dist. #2 Hospital Dist. #2 Hospital Dist. #2
Report form in addition to    (Parish)
respective columns (A-G)
                              3.75%                      4.75%  4.25%             4.75%         5.75%             6.00%             5.25%             5.25%                 5.75%
                                                                          COMPUTATION OF SALES AND USE TAX
13  Adjusted Gross Sales
14  Use Tax Sales
15  Total (lines 13 + 14)
16  Tax
17  Excess tax collected
18  Total (lines 16 + 17)
19  Vendor’s Comp Rate        2.00%                      2.00%  2.00%             2.00%         2.00%             2.00%             2.00%             2.00%                 2.00%
19a V.C. (lines 18 * 19) 
    (if payment not delq)
20  Tax Due (lines 18 - 19a)
21  Delinquent Penalty 
    (see note 1)
22  Interest (see note 2)
23  Total lines 20 + 21 + 22
24  Debit or Credit (note 3)
25  Total (lines 23 + 24)
26  Remittance attached     $                                                     Sales Tax Division                                        Make all remittances payable to 
                                                                                  Vermilion Parish School Board                             Vermilion Parish School Board  
                                                                                  P.O. Box 1508 
                                                                                  Abbeville, Louisiana 70511-1508                                  Sales Tax Division
                                                                                  337-898-5733

       To avoid penalties be sure that you transmit or          Note 1:  5% of tax for each 30 days or fraction thereof, 25% max. 
       postmark this return on or before the 20th of  
                each month following the period covered.        Note 2:  Daily rate of .000411 from due date.                     SALES AND USE TAX REPORT
                                                                Note 3:  Authorized memo must be attached.