For Sheriff’s Office Use Only
Parish Sales Tax Number: Date of Issue:
LA Sales Tax#: ___________________ Federal Tax ID#: ____________________ Federal Standard Industrial Code: ____________
Trade Name on Signs/Advertising: _______________________________________________________________________________
Legal Name (your name/corporate name):_________________________________________________________________________
Mailing Address: _____________________________________________________________________________________________
City: ___________________________________ State: __________________________ Zip Code: ___________________________
Are you inside city limits? Yes________ No _________ If inside List City: _______________________________________________
Do you have in-store sales, delivery sales, or sales on the internet or a combination (be specific)? ____________________________
Physical Address:
Shopping Center:
City: State Zip Code:
Phone Number: __________________________________ Ward Number: _____________
Open Date of Business/ Date Began Sales in St. Tammany Parish: ______________________________
A SEPARATE CERTIFICATE IS REQUIRED FOR EACH LOCATION OF YOUR BUSINESS
If any corporation fails to remit the sales and use taxes collected from purchasers or consumers, the Collector is authorized to hold those officers or
directors personally liable for the total amount of such taxes, together with any interest, penalties, and fees accruing thereon. Collection of the total
amount due may be made from any one or any combination of such officers or directors. A corporation by resolution of the board of directors may
designate an officer or director having direct control or supervision of such taxes, and such resolution shall be filed with the Clerk of Court for the
Twenty-Second Judicial District of Louisiana. If corporation or partnership Name, Title, Social Security Number, Resident Address, and Phone # of
Officers, Directors or Partners.
Owner’s Name: ___________________________________________ Social Security Number: ________________________________
Home Address: ___________________________________________ Home Phone: ________________________________________
City: ______________________________ State: ________________ Zip Code: _______________________________
OFFICERS: (NO P.O. BOXES MAY BE USED FOR THE ADDRESS)
Name: ____________________________________________ Title: _____________________ SSN: ___________________________
Address: _______________________________________________________ Home Phone: _________________________________
City: __________________________________ State: _____________________ Zip Code: __________________________
Name: ____________________________________________ Title: _____________________ SSN: ___________________________
Address: _______________________________________________________ Home Phone: _________________________________
City: __________________________________ State: _____________________ Zip Code: __________________________
Name: ____________________________________________ Title: _____________________ SSN: __________________________
Address: _______________________________________________________ Home Phone: _________________________________
City: __________________________________ State: _____________________ Zip Code: __________________________
Agent’s/Contact’s Name: _____________________________________________________ Phone: ___________________________
Address, City, State, Zip Code: __________________________________________________________________________________
Location of Accounting Records: _________________________________________________________________________________
Detailed Description of Nature of Business: ________________________________________________________________________
If an individual is an applicant for a certificate required by this Ordinance, the application must be signed by him; if a partnership or an association of
persons, by a member of the firm; and if a corporation, by the proper officer thereof. Any intentional false statement as to any material facts in the
application for a certificate shall constitute a misdemeanor.
SIGNATURE OF APPLICANT: __________________________________________ DATE: ______________________
PRINT OR TYPE APPLICANT’S NAME AND TITLE: ______________________________________________________
PARISH WIDE SALES AND USE TAX
REGISTRATION FORM FOR USE IN ALL
CITIES AND UNINCORPORATED AREAS OF
ST. TAMMANY PARISH
SHERIFF’S OFFICE
PLEASE COMPLETE AND RETURN TO:
ST. TAMMANY PARISH
SALES & USE TAX DEPARTMENT
P. O. BOX 1229
SLIDELL, LA 70459
(MAILING ADDRESS IS FOR REGISTRATION APPLICATION INFORMATION ONLY)
(985) 726-7777; (985) 726-7767 Fax
For Sheriff’s Office Use Only
Parish Sales Tax Number: __________________________ Date of Issue: _____________________________
Revised 7-10-2014
click to sign
signature
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