This certicate is for use only by employees of the United States government, the State of Louisiana and its political subdivisions.
Employee Name Government Agency
Agency Address
City State ZIP Agency Contact Number
Authorized Dates of Travel (mm/dd/yyyy - mm/dd/yyyy) Destination
This certies that the employee named above is an employee of the above named government agency and that the travel expenses
incurred are necessitated by the employee’s conduct of the official business of this government agency. These 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. The government agency named above claims exemption from the payment of state and local sales taxes. For hotel room
rental charges (hotel/lodging cots), this exemption certicate is also valid for an exemption from the payment of Louisiana Stadium and
Exposition District and New Orleans Exhibition Hall Authority occupancy taxes. This exemption certicate does not exempt the employee
from payment of local hotel occupancy taxes in other jurisdictions. For additional information regarding hotel occupancy taxes in other
jurisdictions, please contact the jurisdiction directly.
Under penalty of perjury, I declare that I have examined this exemption certificate and accompanying documents, and to the best of my
knowledge and belief it is true, correct, and complete.
Authorization
Employee Signature
Date (mm/dd/yyyy)
Government Agency Representative (other than employee) Government Agency Representative Title (other than employee)
Government Agency Representative Signature
Date (mm/dd/yyyy)
Hotel/Lodging Information
(To Be Completed By Hotel)
Hotel Name
Dates of Employee’s Stay (mm/dd/yyyy-mm/dd/yyyy)
Vehicle Rental Information
(To Be Completed by Vehicle Rental Dealer)
Vehicle Rental Dealer Vehicle Rental Reservation Number
Dates of Vehicle Rental
Vehicle Parking Information
(To Be Completed by Vehicle Parking Dealer)
Vehicle Parking Dealer Vehicle Parking Reservation Number (if applicable)
Dates of Vehicle Parking
Notice to Dealer: Report this sale on the appropriate line of the Louisiana Hotel/Motel sales tax return as exempt room rentals.
R-1376 (9/19)
Governmental Employees Travel
Sales/Use Tax Exemption Certificate
Louisiana Revised Statute 47:301(8)(c)
Louisiana Stadium and Exposition District
New Orleans Exhibition Hall Authority
