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                                                                                                                                                                                                                                                            EDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.1%
                                                                                                                                                                                                                 G2 - 6.75%               OpelousasDDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           P - 6.55%

                            Online                                                                             or
                            File
                            *                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                1.55%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              2%
                                                                                                                                                                                                                 G1 - 6.75%               Central St.Landry EDD Opel City                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        P - 6.55%             Central St.Landry                              EDDUnincorporated
                                                           www.salestaxonline.com
                                                                                                                                                             parishe-file.revenue.louisiana.gov
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               2%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Palmetto
                                                                                                                                                                                                                 G - 5.75%                                  Opelousas                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            O - 3.55%

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                                                                                                                                                                                                                                                            Eunice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Leonville
                                                                                                                                                                                                                 F - 6.0%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N - 3.55%
                                                                                                                                      or

                                Information Please Visit:                                                                                                                                      www.laota.com                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                      Eunice                                                                                                                                                                                                                                                                                                                                   1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       $
                                                                                          www.slp.k12.la.us
                                                                                                                                                                                                                 E - 5.55%                                  Arnaudville                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          M - 2.45%                                                                             (Acadia Parish)

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                                                                                                                                                                                                                                                            EDD                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               1.1%
                                                                                                                                                                                                                 D1 - 7.55%               Grand Coteau                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           L - 2.0%              Arnaudville
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       (St. MartinParish)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               1.1%
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Cankton
                                                                                                                                                                                                                 D - 5.55%                                  Grand Coteau                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         K - 4.55%
                                                                                                                                                                                                             day.
                                                                                                                                                                                                             21st
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             2%
                                                                                                                                                                                                                                                            Melville                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            1.1%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       ENCLOSED (Total for all columns)
                            return is DUE on the first day                                                     covered by the return, and                                                                        C - 5.75%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       J - 4.55%                                               Krotz Springs
                            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% oftax for each30daysorfractionthere- of, not toexceed25% inthe aggregate)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               (5% oftax for each30daysorfractionthere-                                     of, not toexceed25% inthe aggregate)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         ORIGINAL Memo MUST BE ATTACHED(                                          (Line23 plus or minus Line 24)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ORIGINAL Memo MUST BE ATTACHED(                                              (Line23 plus or minus Line 24)

                                                                                                                                                                                                                 COMPUTATION OF SALES AND                                                                                                                                     PURCHASESSUBJECT TO USETAXIN EACH JURISDICTION                                                                                                                                                                                                                                                                                                                                              (Deductibleonly if paid timely)                                                                                                                                                                                                                                                              TAXDEBIT OR CREDIT                                                                     COMPUTATION OF SALES AND                                                                                                                                PURCHASESSUBJECT TO USETAXIN EACH JURISDICTION                                                                                                                                                                                         (Deductibleonly if paid timely)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           TAXDEBIT 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.EXCESSTAXCOLLECTED                                                18.TOTAL (Add Line 16 plus Line 17)                                             19.VENDOR'S COMPENSATION                                       20.NETTAXDUE(Line 18 minus Line 19)                                                        21.DELINQUENT PENALTY                22.INTEREST (15% perannum from date dueuntil paid) 23.TOTAL TAX, PENALTY ANDINTEREST DUE                               24.                                        25.TOTAL AMOUNTDUE                                                                                                                                     13.ADJUSTED GROSS SALES IN EACH JURISDICTION                           14.                  15.TOTAL (Line 13 plus Line 14) 16.TAX: PERCENT AS SHOWN IN EACH COLUMN                          17.EXCESSTAXCOLLECTED 18.TOTAL (Add Line 16 plus Line 17)     19.VENDOR'S COMPENSATION                                                                                                                                                  20.NETTAXDUE(Line 18 minus Line 19)                                                                                                                                      21.DELINQUENT PENALTY                                                                                                   22.INTEREST (15% perannum from date dueuntil paid) 23.TOTAL TAX, PENALTY ANDINTEREST DUE                                                  24.                         25.TOTAL AMOUNTDUE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              be
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              to

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 my                                                                                                                                                                                                                                                                                                                                                                                                                                                          DATE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              the matters required
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 the best                                                                                                                                     to

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 examined                                                                                                                                     all the information relating

                                                                                                                                                                                                                                                                                                                                                                                                                             ALLOWABLE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        based on                                                                                                                                                                                                                                                                                                                                                             LA TAXIDENTIFICATION NO.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  CHANGE OF STATUS REPORT

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 AUTHORIZED SIGNATURE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             MAILING ADDRESS CHANGE
                                                                                                                                                                                                                                                                           GROSS SALES OF TANGIBLE PERSONAL PROPERTY,LEASES, RENTALS & SERVICES AS REPORTED TO THESTATE OF LA                                                                                                                                                                        CASH DISCOUNTS, RETURNS, ANDALLOWANCES                       SALES DELIVEREDOR SHIPPED OUTSIDE OF ST.LANDRY                                     SALESOF GASOLINE ANDOTHER ROAD USEFUELS                              SALES TO TAXEXEMPTGOVERNMENT AGENCIES SALES OF FOOD PURCHASEDWITH USDA FOOD STAMPS/ WIC                                                                                                                                                                                                      TOTAL ALLOWABLEDEDUCTIONS (Lines2 Thru 10) ADJUSTED GROSS SALES (Line 1 minus Line 11)                                                                                                                                                         DATE BUSINESS CLOSED/ SOLD
ST. LANDRY PARISH                                          SALES & USE TAX REPORT                                                                                                                                                                                          1.                                                                                                                                                                                           2. SALES FORRESALEFURTHER 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               beliefisa true, correct, and completereturn. If the returnispreparedbya personother thanthe taxpayer, his declaration is                                                                                     reportedinthe returnofwhich hehas any knowledge.






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