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                         R-1029 (7/22) 
                         Louisiana Department of Revenue
                         Sales Tax Return
                         Location address:
                          ADDRESS
Field flag                CITY                              STATE        ZIP

                                                                                                                   ACCOUNT 
                                                                                                                   NUMBER
                                                                                                                    LEGAL NAME
                                                                                                                    TRADE NAME
                            Do not use this form 
FOR OFFICE USE ONLY.        for filing periods prior                                                                MAILING ADDRESS               UNIT TYPE UNIT NUMBER
                            to July 2022.                                                                           CITY                      STATE         ZIP
                            Filing period                   M M     Y Y                                             FOREIGN NATION, IF NOT UNITED STATES (DO NOT ABBREIVATE)
                             U.S. NAICS                                                                                        Please use blue or black ink.
                             Code                                                                                             Round to the nearest dollar. Do not use dashes.

                     1 Gross sales of tangible personal property                                                              1

                     2 Cost of tangible personal property                                                                     2
                       (Used, consumed, or stored for use or consumption in Louisiana.)

                     3 (a) Leases and rentals of tangible personal property                                                   3(a)
                       (Do not include motor vehicle leases or rentals, which must be filed electronically. See instructions.)

                       (b) Taxable services                                                                                   3(b)

                     3 Total leases, rentals, and taxable services (Add Lines 3(a) and 3(b).)                                 3

                     4 Total (Add Lines 1, 2, and 3.)                                                                         4

                     5 Total allowable deductions (From Line 32, Schedule A. Do not                                           5
                       include as a deduction any item not reported on either Line 1, 2, or 3.)  
                     6 Amount taxable (Subtract Line 5 from Line 4.)                                                          6

                     7 Tax due (Multiply amount on Line 6 by 4.45%.)                                                          7

                     8 Excess tax collected (Do not include local sales tax.)                                                 8

                     9 Total (Add Line 7 and Line 8.)                                                                         9

                     10 Vendor’s compensation 0.944% (0.944% of Line 9 if not delinquent. Limited to $1500. The               10
                       0.944% rate is the equivalent of 4 cents out of 4.45 cents of the 1.05% V.C. rate. See instructions.)

                     11 Net tax due (Subtract Line 10 from Line 9.)                                                           11

                     11 (a) Donation to The Louisiana Military Family Assistance Fund                                         11(a)
                            (Enter the amount from Line 33 from the back of the return.)

                     12  Penalty (See instructions.)                                                                          12 

                     13 Interest (See instructions.)                                                                          13
                                                                                                 Mark this box if  
                     14 Total payment due (Add Lines 11, 11(a), 12, and 13.)                     payment made 
                       Make payment to: Louisiana Department of Revenue.                         electronically.
                                       PAY THIS AMOUNT  (DO NOT SEND CASH.)                      u                            14

WEB
Each physical location must register to  
obtain a separate Revenue Account ID.                                    Taxpayer’s FEIN                                       Parent Company FEIN

                                                      Final          Enter date                                                If amended return, 
                                                                      business 
                                                     return   sold/terminated.                                                 mark this box.               42273

R-1029 (7/22)                                                                    Percent 
Allowable Deductions – Schedule A                                Total Sales     Exempt
 15 Intrastate telecommunication services                                        22.472%
    (Do not include prepaid telephone cards.)
 16 Interstate telecommunication services                                        44.944%

 17 Prepaid telephone cards                                                      22.472%

18  Electricity and natural gas or energy for non-                               55.056%
    residential use 

 19 Steam and bulk or utility water used for non-                                55.056%
    residential purposes

 20 Boiler fuel for nonresidential use                                           55.056%
    (See instructions.)

 21 Sales/purchase/leases/rentals of manufactur-                                 100%
    ing machinery or equipment
 22 Sales to U. S. government and Louisiana                                      100%
    state and local government agencies 
 23 Sales of prescription drugs                                                  100%

 24 Sales of food for home consumption                                           100%

 25 Electricity, natural gas, and bulk water for                                 100%
    residential use
 26 Sales in interstate commerce                                                 100%

 27 Sales for resale                                                             100%

 28 Cash discounts, sales returns and                                            100%
    allowances
 29 Tangible personal property sold for lease or                                 100%
    rental (See instructions.)
 30 Sales of gasoline, diesel, and motor fuel                                    100%
    (Sales for resale must be reported on Line 27.)
 31 Total from SCHEDULE A-1                                                      100%
     (Transactions taxed at 0%.) 

 32 Add Lines 15 through 31; enter here and on Line 5.
                        33(a)  Donation of Vendor’s Compensation             33(b)  Donation in Addition to Tax Due
The Military Family 
Assistance Fund 
Worksheet
33 Total Donation (Add Lines 33(a) and 33(b)) Enter here and on Line 11(a) on front of return. ................................................................  33

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature                                                                                                                                                        Date (mm/dd/yyyy)

Print Name                                            Title                                                                                                      Telephone

                     Print Preparer’s Name            Preparer’s Signature               Date (mm/dd/yyyy)                                                                        Check ■■ if  
    PAID                                                                                                                                                                          Self-employed
PREPARER               Firm’s Name ➤                                                                               Firm’s EIN                                         ➤
USE ONLY             Firm’s Address ➤                                                                              Telephone                                          ➤

                                                      PTIN, FEIN, or LDR account                                   For Office  
                                                      number of paid preparer                                      Use Only.

                                        Louisiana Department of Revenue • Post Office Box 3138 • Baton Rouge, LA  70821-3138
                                 This return is due on or before the 20th day following the taxable period covered and becomes delinquent on                                      42274
                                 the first day thereafter. If the due date falls on a weekend or holiday, the return is due the next business day and 
                                 becomes delinquent the first day thereafter.

R-1029 (7/22)
             Enter your Louisiana Revenue Account Number:

             Schedule A-1: Transactions Subject To 0% Tax
Description  Sales Tax                                                                      Total Sales
             Exemption Code

  1

  2

  3

  4

  5

  6

  7

  8

  9

 10

 11

 12

 13

 14

 15

 16

 17

 18

 19

 20

 21 Add Lines 1 - 20; enter here and on Line 31 of Schedule A, under the Total Sales column.

                                                                                                       42275