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                                                                                                                                                                                                                                                      EDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2%
                                                                                                                                                                                                          G2 - 6.75%               Opelousas DDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               P - 6.55%             Central St. Landry                             EDD Unincorporated

                            Online                                                                           or
                            File                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          1.55%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           2%
                            *                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Palmetto
                                                                                                                                                                                                          G1 - 6.75%               Central St. Landry EDD Opel City                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            O - 3.55%
                                                                       www.salestaxonline.com
                                                                                                                                                           parishe-file.revenue.louisiana.gov
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Leonville
                                                                                                                                                                                                          G - 5.75%                                   Opelousas                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                N - 3.55%

                                                                                                                                                                                                                                                      Eunice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                       Eunice                                                                                                                                                                                                                                                                                                                                               1.1%
                                                                                                                                                                                                          F - 6.0%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             M - 2.45%                                                                              (Acadia Parish)
                                                           Information:

                                                                                                                                        www.laota.com                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  $
                                                                                                         http://www.slpsb.org                                                                             E - 5.55%                                   Arnaudville                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              L - 2.0%              Arnaudville
                                                           For More                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   (St. Martin Parish)

                                                                                                                                                                                                                                                      EDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            1.1%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Cankton
                                                                                                                                                                                                          D1 - 7.55%               Grand Coteau                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                K - 4.55%

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            1.1%
                                                                                                                                                                                                          D - 5.55%                                   Grand Coteau                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             J - 4.55%                                               Krotz Springs
                                                                                                                                                                                                     day.
                                                                                                                                                                                                     21st                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              EDD
                                                                                                                                                                                                                                                      Melville                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  ENCLOSED (Total for all columns)

                            return is DUE on the first day                                                   covered by the return, and                                                                   C - 5.75%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            I 1- 7.55%                                              Sunset
                            This                                       of the month following the period                                                   becomes DELINQUENT on the

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          2%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Sunset                                                                                                                                                                                                                                                                                                             1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  REMITTANCE 
                                                                                                                                                                                                          B - 4.75%                                   Washington                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               I - 5.55%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                26.

              To:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          2%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.1%
                                                                                                                                        (337) 942-0238                                                    A - 5.55%                                   Unincorporated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           H - 5.75%                                               Port Barre

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   )                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    )
                                                                                                         - Opelousas, LA 70571-1210                                                                       TAX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               TAX
              Remit Payments
                                                                                                                                                                                                          USE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               USE
                                                                       St. Landry Parish School Board    Box 1210                       For Assistance Call
                                                                                                         P.O.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (5% of tax for each 30 days, or fraction thereof, not to exceed 25%)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (5% of tax for each 30 days, or fraction                            thereof, not to exceed 25%)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     ORIGINAL Memo MUST BE ATTACHED(                                            (Line 23 plus or minus Line 24)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           ORIGINAL Memo MUST BE ATTACHED(                                               (Line 23 plus or minus Line 24)

                                                                                                                                                                                                          COMPUTATION OF SALES AND                                                                                                                                        PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION                                                                                                                                                                                                                                                                                                                                                           (Deductible only if paid timely)                                                                                                                                                                                                                                                             TAX DEBIT OR CREDIT                                                                      COMPUTATION OF SALES AND                                                                                                                                   PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION                                                                                                                                                                                                (Deductible only if paid timely)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 TAX DEBIT OR CREDIT
                                                                                                                                                                                                                                                                     13. ADJUSTED GROSS SALES IN EACH JURISDICTION                                                        14.                                                          15. TOTAL (Line 13 plus Line 14)                                        16. TAX: PERCENT AS SHOWN IN EACH COLUMN                                         17. EXCESS TAX COLLECTED                                                  18. TOTAL (Add Line 16 plus Line 17)                                              19. VENDOR'S COMPENSATION                                         20. NET TAX DUE (Line 18 minus Line 19)                                                      21. DELINQUENT PENALTY      22. INTEREST (12% per annum from date due until paid) 23. TOTAL TAX, PENALTY AND INTEREST DUE                               24.                                          25. TOTAL AMOUNT DUE                                                                                                                                     13. ADJUSTED GROSS SALES IN EACH JURISDICTION                            14.                    15. TOTAL (Line 13 plus Line 14) 16. TAX: PERCENT AS SHOWN IN EACH COLUMN                          17. EXCESS TAX COLLECTED 18. TOTAL (Add Line 16 plus Line 17)     19. VENDOR'S COMPENSATION                                                                                                                                                   20. NET TAX DUE (Line 18 minus Line 19)                                                                                                                                                21. DELINQUENT PENALTY                                                                                     22. INTEREST (12% per annum from date due until paid) 23. TOTAL TAX, PENALTY AND INTEREST DUE                                                   24.                         25. TOTAL AMOUNT DUE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        be
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        to

                                                                                                                                                                                             PERIOD:      CHECK#                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             knowledge and
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             my                                                                                                                                                                                                                                                                                                                                                                                                                                                                 DATE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        the matters required
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             the best                                                                                                                                                   to

                                                                       TAX ID. NO.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           and to
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   BUSINESS LOCATION CHANGE                                                                                                                                                                                                                                  me
                                                                                                                                                                                                                                                                                                                                                                                                                            DEDUCTIONS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 NAME / ADDRESS OF NEW OWNER                                                                                                                                                                                                                                                                                                                                                           by

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             examined                                                                                                                                                   all the information relating

                                                                                                                                                                                                                                                                                                                                                                                                                            ALLOWABLE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   based on                                                                                                                                                                                                                                                                                                                                                       LA TAX IDENTIFICATION NO.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                CHANGE OF STATUS REPORT

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    AUTHORIZED SIGNATURE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   MAILING ADDRESS CHANGE
                                                                                                                                                                                                                                                                     GROSS SALES OF TANGIBLE PERSONAL PROPERTY, LEASES, RENTALS & SERVICES AS REPORTED TO THE STATE OF LA                                                                                                                                                                               CASH DISCOUNTS, RETURNS, AND ALLOWANCES                          SALES DELIVERED OR SHIPPED OUTSIDE OF ST. LANDRY                                      SALES OF GASOLINE AND OTHER ROAD USE FUELS                             SALES TO TAX EXEMPT GOVERNMENT AGENCIES SALES OF FOOD PURCHASED WITH USDA FOOD STAMPS / WIC                                                                                                                                                                                                  TOTAL ALLOWABLE DEDUCTIONS (Lines 2 Thru 10) ADJUSTED GROSS SALES (Line 1 minus Line 11)                                                                                                                                                            DATE BUSINESS CLOSED / SOLD
ST. LANDRY PARISH                                                      SALES & USE TAX REPORT                                                                                                                                                                        1.                                                                                                                                                                                                 2. SALES FOR RESALE FURTHER PROCESSING                                          3.                                                               4.                                                                                    5.                                                                     6.                                      7.                                                                                           8.                          9.                                                    10.                                                                   11.                                          12.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      I declare under the penalties for filing false reports that this return (including any accompanying schedules and statements) has been                   belief is a true, correct, and complete return.  If the return is prepared by a person other than the taxpayer, his declaration is                                                                   reported in the return of which he has any knowledge.






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