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                 SALES AND USE TAX REPORT
                    BOSSIER CITY - PARISH SALES AND USE TAX DIVISION
                    PO BOX 71313  BOSSIER CITY, LOUISIANA 71171-1313
       PHONE (318) 741-8551    FAX (318) 741-8997    www.Bossiercity.org
    GROSS SALES OF TANGIBLE AND PERSONAL PROPERTY, LEASES, RENTALS
1     AND SERVICES AS REPORTED TO THE STATE OF LOUISIANA                                                                          1
                             ALLOWABLE DEDUCTIONS                                                                                                                 MONTH(S) OF                                                  YR
2  SALES FOR RESALE OR FURTHER PROCESSING (CERTIFICATE ON FILE)
3  CASH DISCOUNTS, SALES RETURNS & ALLOWANCES
4  SALES DELIVERED OR SHIPPED OUTSIDE THIS JURISDICTION
5  SALES OF GASOLINE AND MOTOR FUELS                                                                                                                                                                  OFFIC E USE ONLY                                      OFFICE USE ONLY
6  SALES TO AGENCIES OF THE US GOVERNMENT, THE STATE 
        OF LOUISIANA AND ITS POLITICAL SUBDIVISIONS                                                                                                            PLEASE INDICATE ANY CHANGES BELOW:
7  SALES OF FOOD PAID FOR WITH USDA FOOD STAMPS OR WIC VOUCHERS.                                                                                               DATE OUT OF BUSINESS                                            DATE BUSINESS SOLD
           OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)                                                                                                NAME OF NEW OWNER
8
9                                                                                                                                                          COMMENTS:
10  
11  TOTAL ALLOWABLE DEDUCTIONS (LINE 2 THRU 10)                                                                                   11                                                                  CONSOLIDATED SALES & USE TAX REPORT FOR BOSSIER PARISH, LA.
12  ADJUSTED GROSS SALES (LINE 1 MINUS LINE 11)                                                                                                                         -                             COMPLETE ONLY THOSE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS
                                                                                                                                     SCHOOL BOARD    SCHOOL BOARD             SCHOOL BOARD                    SCHOOL BOARD         SCHOOL BOARD    SCHOOL BOARD                   RESERVED
                                                                                                                                     BOSSIER CITY    BENTON                   HAUGHTON                        PLAIN DEALING        POLICE JURY     POLICE JURY                        for
                                                                                                                                     POLICE JURY     POLICE JURY              POLICE JURY                              POLICE JURY LAW ENFORCEMENT LAW ENFORCEMENT                Boomtown
                                                                                                                                     LAW ENFORCEMENT LAW ENFORCEMENT          LAW ENFORCEMENT                 LAW ENFORCEMENT                                                     Casino
   COMPUTATION OF SALES AND USE TAX                                  TOTAL RATETOTAL OF COLUMNS                                             5.00% A  5.25% B                                          5.25% C          5.25% D     2.50% E                  4.25% F               2.50% G
13 ADJUSTED GROSS SALES IN EACH JURISDICTION                                 MUST  EQUAL LINE 12                                  13
14 PURCHASES SUBJECT TO USE TAX IN EACH JURISDICTION                                                                              14
15 TOTAL (LINE 13 PLUS LINE 14)
16 TAX DUE- MULTIPLY LINE 15 BY % SHOWN IN COLUMN                                                                                 16
17 EXCESS TAX COLLECTED                                                                                                           17
18 TOTAL (LINE 16 PLUS LINE 17)
                                                                          DEDUCTIBLE ONLY WHEN                                             
19 VENDORS COMPENSATION 1% OF LINE 18                             PAYMENT IS NOT DELINQUENT                                       19

21 DELINQUENT PENALTY                                                                                                             21
20 NET TAX DUE (LINE 18 MINUS LINE 19) COMPUTED5% OFFROMTAX FORTHEEACHDAY AFTER30 DAYS25%THEORDUEFRACTIONDATE NOTTHEREOFTO EXCEED 
22 INTEREST .7917% PER MONTH           CALCULATED FROM DATE DUE UNTIL PAID.                                                       22
23 TOTAL TAX, PENALTY AND INTEREST DUE                                                                                                                                                                                                                                                     
24 TAX DEBIT OR CREDIT (AUTHORIZED MEMO MUST BE ATTACHED)                                                                         24
25 TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)                                                                               25
     This return DUE  on the 1st day of month following period covered by this return                                                                           TOTAL OF COLUMNS  A  +  B  +  C  +  D  +  E  +  F                                  LINE 26.         TOTAL REMITTED
     and  becomes DELINQUENT if not transmitted on or before the 20th day.                                                                                   *THIS AREA IS ALSO WITHIN THE CITY OF SHREVEPORT
                                                                                                                                                                                                                                                                    $
    Acct #
                                                                                                                                                     STATE TAX I.D.#
                                                                                                                                                                                                                                                             OFFICE USE ONLY
                                                                                                                                                                                                                                                            REMITTANCES PAYABLE TO
                                                                                                                                                                                                                                                            BOSSIER CITY - PARISH
                                                                                                                                                                                                                                                            SALES AND USE TAX DIVISION
                                                                                                                                            SIGNATURE OF                                              
                                                                                                                                            INDIVIDUAL OR AGENT                                                                                      DATE 
                                       ORIGINAL                                                                                                      WARNING:                 DO NOT use any other taxpayer's return as this will result in improper credit.
                                                                                                                                                                              DO NOT ignore delinquent notices - Negligence penalties may be imposed.