WASHINGTON PARISH SHERIFF’S OFFICE SALES AND USE TAX REPORT 
                                                                                         WASHINGTON PARISH 
                                                                                              SHERIFF’S OFFICE 
                                                                                 SALES AND USE TAX DEPARTMENT 
                                                                                              1002 Main Street 
                                                                                 FRANKLINTON LOUISIANA 70438 
                                                                                 (985) 839-3434/FAX (985) 839-6581 
STATE OF LOUISIANA TAX I.D. NO.                                                                        MONTH OF                                                                                         
1 GROSS SALES OF TANGIBLE PERSONAL PROPERTY. LEASES, RENTALS                                                                                        Make all Remittances                                                   
                                                                                                                                                                                        Payable to                         
         AND SERVICES AS REPORTED TO THE STATE OF LA 
                          ALLOWABLE DEDUCTIONS                                                                                                      WASHINGTON PARISH                                                      
2  SALES FOR RESALE                                                                                                                                   SHERIFF’S OFFICE                                                     
3  CASH DISCOUNTS, SALES RETURNS AND ALLOWANCES                                                                                           SALES TAX DEPARTMENT                                                             
4  SALES DELIVERED OR SHIPPED OUTSIDE THIS JURISDICTION                                                                                                                                                                    
5  SALES OF GASOLINE AND MOTOR FUELS                                                                                                         PARISH OF WASHINGTON                                                          
6  SALES TO AGENCIES OF THE U.S. GOVT., THE STATE OF LOUISIANA AND                                                                                                                      LOUISIANA                          
   ITS POLITICAL SUBDIVISIONS                                                                                                                                                                                              
7  SALES OF FOOD PAID FOR WITH USDA FOOD STAMPS OR WIC VOUCHER                                                                            SALES AND USE TAX REPORT                                                          
           OTHER DEDUCTIONS AUTHORIZED BY LAW (Explain Briefly)                                                                                                                                                          
8                                                                                                                                         This return is DUE on the 1st day of the                                       
9                                                                                                                                         month following the period covered by the                                      
10                                                                                                                                        return, and becomes DELINQUENT on                                              
11  TOTAL ALLOWABLE DEDUCTIONS (Lines 2 thru 10)                                                                                                                                       the 21st  day.                       
12  ADJUSTED GROSS SALES (Line 1 minus line 11)                                                                                                                                                                             
COMPUTATION OF SALES AND USE TAX                                                              COMPLETE ONLY THOSE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS                                                                
                                                                                         Domicile      Domicile   Domicile Code     Domicile            Domicile Code                                 Domicile Code 
CONSOLIDATED SALES & USE TAX REPORT FOR                                                  Code 5903     Code 5902      5901          Code 5905                                           5904           5906 
                                                                                         A – 4.83%     B - 5.493%     C – 5.5%      D – 4.83%                                          E – 3.83%       F – 4.83% 
                                                                                                                                                        Within the 4th                                All other areas   
WASHINGTON PARISH, LOUISIANA                                                             Within the    Within the    Within the     Within the                                         WARD but         of 
                                                                                        VILLAGE OF     CITY OF       TOWN OF       VILLAGE OF                                           outside       WASHINGTON 
                                                                                         ANGIE         BOGALUSA   FRANKLINTON       VARNADO                                            Bogalusa        PARISH 
                                                                                                                                                                                        Limits 
13  ADJUSTED GROSS SALES IN EACH JURISDICTION                                                                                                                                                          
(Total of Columns must equal line 12)                                                                                                                                                                                    
14  PURCHASE SUBJECT TO USE TAX IN EACH JURISDICTION                                                                                                                                                   
15  TOTAL (Line 13 plus line 14)                                                                                                                                                                       
16  TAX    (% of line 15)  multiply line 15 by percent shown at top of column(s)                                                                                                                       
17  EXCESS TAX COLLLECTED                                                                                                                                                                              
18  TOTAL (Line 16 plus line 17)                                                                                                                                                                       
19  VENDOR'S COMPENSATION (1% of line 18 deductible                                                                                                                                                    
       only when payment is not delinquent                                                                                                                                                             
20  NET TAX DUE (Line 18 minus line 19)                                                                                                                                                                
21  DELINQUENT PENALTY (5% of tax for each 30 days or                                                                                                                                                  
      fraction thereof of delinquency, not to exceed 25% in the aggregate 
22  INTEREST (1.00% per month or fractional part thereof,                                                                                                                                              
from date due until paid) 
23  TOTAL TAX, PENALTY AND INTEREST DUE                                                                                                                                                                
24  TAX DEBIT OR CREDIT   (Authorized memo must be attached)                                                                                                                                           
25  TOTAL AMOUNT DUE (Line 23 plus or minus line 24)                                                                                                                                                   
26  REMITTANCE ATTACHED                                                                                       TOTAL OF LINE 25 (COLUMNS A, B, C,D,E,F) 
 
ACCT #:                                                                          SIGNATURE OF                                                                                          
ACCT NAME:                                                                       INDIVIDUAL OR AGENT                                            DATE                                                    
           
PLEASE INDICATE ANY CHANGES BELOW:                                               WARNING: DO NOT use any other taxpayer’s returns as this will result in improper credit 
NAME OF NEW OWNER                                                                           DO NOT ignore delinquent notices  –negligence penalties may be imposed      
DATE OUT OF BUSINESS                   
DATE BUSINESS SOLD                                                                      
                                                                                                                                OFFICE USE ONLY 
COMMENTS: