Louisiana Application for Sales Tax Exemption Certificate for Charitable Institutions

Application for Sales Tax Exemption Certificate for Charitable Institutions
untitled
R -1385 (9/07)

Application for Sales Tax Exemption
Certificate for Charitable Institutions
Revised Statute 47:315.5
Taxpayer Services Division
P.O. Box 66362
Baton Rouge, LA 70896-6362
(225) 219-7356
(225) 231-6236 (Fax)

Please print or type.
Charitable Institution Name

Telephone Number

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Business Address

City

State

ZIP

The above charitable institution hereby applies for the restricted refund of state sales and use tax allowed by Revised
Statute 47:315.5.
In applying for the sales/use tax exemption the organization certifies the following:
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It is qualified for exemption from federal income taxation under Section 501(c)(3) of the Internal Revenue Code.
Its principal place of business is within the state.
It routinely sells donated tangible personal property or items made from such donated property.
It spends at least 75 percent of its annual revenue on job training, job placement, and/or the direct employment of,
or other related community services or support programs for, people with workplace disabilities or disadvantages.

The organization further certifies the restricted refund will be used exclusively in this state for one or more of the following purposes:
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land acquisition
capital construction
purchase of capital equipment
debt service related to land acquisition, capital construction or capital equipment
job training,
job placement or employment
other related community services and support program costs. (Please list).

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Please print or type.
Officer completing the application for the organization.
Name

Title

Signature

Date (mm/dd/yyyy)

X

FOR OFFICIAL USE

■ Approved
■ Disapproved

Signature of Department Representative

Date (mm/dd/yyyy)