Fillable Governmental Employees Travel Sales/Use Tax Exemption Certificate This (Louisiana Delta Community College)

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Governmental Employees Travel Sales/Use Tax Exemption Certificate This (Louisiana Delta Community College)

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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
This certicate 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 certies 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 certicate 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 certicate 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.
Employee Signature
Authorization
Government Agency Representative (other than employee)
Government Agency Representative Signature
Date
(mm/dd/yyyy)
Government Agency Representative Title (other than employee)
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
1. This certicate documents the employee’s eligibility for exemption from payment of certain sales & use taxes on authorized travel
expense charges that are directly reimbursable by the government employer.
2. The signatures certify:
• The person named above is an employee of the government employer named above;
• The travel expense charges incurred are necessary for the employee to conduct official business for the government employer; and
• The employee’s travel expenses are accounted for and reimbursable by the government employer to the employee.
3. Authorized travel expenses and charges include:
• Enterprise Rental Car (all Louisiana locations);
• Park N Fly (New Orleans only); and
• Hotel/Lodging Costs for the occupancy of the employee’s hotel room (excluding other taxable hotel purchases, i.e., meals, laundry,
dry cleaning, vehicle parking, incidentals or damages).
4. For hotel room rental charges (hotel/lodging costs), this form is also valid for an exemption from the payment of Louisiana Stadium and
Exposition District and New Orleans Exhibition Hal Authority occupancy taxes, and state and local sales/use taxes.
5. This form does not exempt the holder from payment of local room occupancy taxes. For additional information regarding hotel occu-
pancy taxes in other jurisdictions, please contact the government agency directly.
6. When this form bears only the employee’s signature, it must be accompanied by a copy of the employee’s written travel orders that
show the dates and destination of the authorized travel. Vendors must retain this certicate and a photocopy of the travel orders to
document the exemption.
7. Vendors must retain this certicate for their records.
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Governmental Employees Travel SalesUse Tax Exemption Certificate This (Louisiana Delta Community College)

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Completed 16 September 2020

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