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R-1056 (10/07)
Certicate of Sales/Use Tax Exemption/
Exclusion of Purchases by Political
Subdivisions of the State of Louisiana
Louisiana R.S. 47:301(8)(c)
The above referenced entity does hereby certify that the entity is a public agency of the State of Louisiana with legal status
as one of the following:
State agency, board or commission
Municipal government or instrumentality thereof
Public Charter School (R.S. 17:3971-4001)
Hospital service district
Public housing authority
Parish government or instrumentality thereof
Parish school board or public school
Law enforcement district
Waterworks district
Parish and municipal libraries
Other
Purchases of tangible personal property and taxable services, and/or leases and rentals of tangible personal property
by the above referenced political subdivision are totally exempted from the sales tax levied by the State as provided by
R.S. 47:301(8)(c). The Louisiana Constitution, Article VI, §44(2) de nes a political subdivision as “a parish, municipality, and
any other unit of local government, including a school board and a special district, authorized by law to perform governmen-
tal functions”.
The authorized person for the political subdivision certi es that the entity meets the criteria for the sales tax exclusion under
R.S. 47:301(8)(c), and if sales tax is later found to be due, the entity will be responsible for any tax liabilities.
Signature of Authorized Agent
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Authorized Agent Title
Signature
X
Date (mm/dd/yyyy)
Political Subdivision Louisiana Dept. of Revenue Registration No. (if applicable)
Address
City State ZIP
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