Governmental
Employees
Hotel
Lodging
Sales/Use
Tax
Exemption
Certificate
Lowswna
Rov1sed Statute 47
301(8){c)
This certificate is for use by employees of the United States government and the State of Louisiana and its political subdivisions.
It
is used
to document employee eligibility for exemption from payment of state sales taxes
on
hotel lodging charges that are directly reimbursable
by the government employer.
PLEASE PRINT OR TYPE.
Employee Name
Hotel Folio
or
Reference
Number
Employee Title Government Agency Employer
Agency's Address
City
I State I ZIP
Agency's Telephone Number
This certifies that the employee named above
is
an employee of the above named government agency and that the lodging charges
incurred are necessitated by the employee's conduct of the official business of this government agency. The employee's lodging expenses
are required to be accounted for to his government agency employer and are reimbursable
by
the government agency to the employee
in
the actual amount incurred. This government agency, therefore, claims exemption from the payment of state sales taxes on the lodging
charges for the occupancy of the employee's hotel room.
Authorization
Employee Name
Employee Title
Employee Signature
Date (mmlddlyyyy)
Government Agency Representative (other than employee)
Government Agency Representative Title (other than employee)
Government Agency Representative Signature
Date
(mmlddlyyyy)
Seller's Louisiana Sales
Tax
Registration Number
(if
applicable)
Dates
of
Employee's Stay (mmlddlyyyy)
Note:
This
form is valid only for documenting eligibility for exemption from the payment
of
state sales tax on charges for room occupancy.
The
state sales tax must
be
paid
on other taxable purchases from the hotel, including meals, laundry, dry cleaning,
and
vehicle
parking. When this form bears the signature
of
only the employee, the form must
be
accompanied
by
a
copy
of
the employee's
written travel orders which states the dates
and
destination
of
the authorized travel.
The
hotel must retain this certificate
and
a
photocopy
of
the travel orders
to
document the exemption.
This
form is not valid
to
document exemption from the payment
of
local
room
occupancy
taxes.
