R-1029 (7/12) Louisiana Department of Revenue Sales Tax Return Please paperclip attachments here. Location address: Address City State If address is different from that shown, mark here and make corrections in area provided on back. Do not use this form for filing periods prior to July 2012. Filing period ZIP Account Number * Name(1) * * * * Name(2) Address(1) Address(2) City State ZIP mm/yyyy Please use blue or black ink. U.S. NAICS Code Round to the nearest dollar. Do not use dashes. 1 Gross sales of tangible personal property ...................................................... 1 2 Cost of tangible personal property (Used, consumed, or stored for use or consumption, or purchased or imported to be sold in coin-operated vending machines)............................................. 2 3 Leases, rentals, and services (Do not include motor vehicle leases or rentals, which must be filed electronically. See instructions.) ...................................... 3 4 Total (Add Lines 1 through 3.) .................................................................................. 4 5 Total allowable deductions (From Line 34, Schedule A. Do not include as a deduction any item not reported on Lines 1 through 3.) ................................................. 5 6 Amount taxable (Subtract Line 5 from Line 4.) ........................................................ 6 7 Tax due (Multiply amount on Line 6 by 4%.) .............................................................. 7 8 Excess tax collected (Do not include local sales tax.).............................................. 8 9 Total (Add Line 7 and Line 8.) .................................................................................. 9 10 Vendor’s compensation (1.1% of Line 9, if payment not delinquent)....................... 10 11 Gross tax due (Subtract Line 10 from Line 9.)........................................................ 11 12A Register reprogramming credit (Actual programming costs, not to exceed $25 per register - invoices must be attached).................................................12A 13 Net tax due (Subtract Line 12A from Line 11. If Line 12A exceeds Line 11, please see instructions.).................................................... 13 13A Donation to The Louisiana Military Family Assistance Fund (Enter the amount from Line 35 from the back of the return.).............................................13A 14 Penalty (See instructions.)...................................................................................... 14 15 Interest (See instructions.)..................................................................................... 15 16 Total payment due (Add Lines 13, 13A, 14, and 15.) payment to: Louisiana Department of Revenue. Make PAY THIS AMOUNT Mark this box if payment made electronically. (DO NOT SEND CASH.) u ....... 16 17 Overpayment to be refunded ......................................................................... 17 (Add Lines 11 and 13A and subtract Line 12A. Do not claim a credit for this overpayment on any other return.) If final or amended return, mark boxes on back of this form. SPEC CODE , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . , , , , . . 4010 American LegalNet, Inc. www.FormsWorkFlow.com 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 R-1029 (7/12) Allowable Deductions – Schedule A Total Sales % Exemption 18 Intrastate telecommunication services (Do not include prepaid telephone cards.) 25% 19 Interstate telecommunication services 50% 19 20A Electricity and natural gas or energy for non-residential use 100% 20A 20B Steam and bulk or utility water used for other than residential purposes 100% 20B 20C Other transactions subject to 1% tax including sales of coal, lignite and nuclear fuel. 75% 20C 21 Prepaid telephone cards 25% 21 22 Sales/purchases/leases/rentals of manufacturing machinery or equipment 100% 22 23 Sales to loggers and paper and wood manufacturers (see instructions) 75% 23 100% 24 25 Tangible personal property sold for lease or rental (See instructions.) 100% 25 26 Sales to U.S. government and Louisiana state and local government agencies 100% 26 27 Prescription drugs and medical properties 100% 27 28 Sales of food for home consumption 100% 28 29 Electricity, natural gas, bulk water, and all other fuels for residential use 100% 29 30 Sales in interstate commerce and repairs delivered to another state 100% 30 31 Sales for resale 100% 31 32 Cash discounts, sales returns, and allowances 100% 32 100% , , , , , , , , , , , , , , , , , , , 18 33 ­­ 24 Sales Tax Holiday sales 33 Other totally tax-exempt sales (Explain.) (Do not include bad debt write-offs from prior period sales.) 34 34 Add Lines 18 through 33; enter here and on Line 5. The Military Family Assistance Fund Worksheet 35A Donation of Vendor’s Compensation . , 35B Donation in Addition to Tax Due , 00 . , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . . . 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 35C Donation of Refund 00 35 Total Donation (Add Lines 35A, 35B, and 35C.) Enter here and on Line 13A on front of return........................................................ 35 , , . . 00 00 Complete applicable lines for address changes only: New mailing address_____________________________________ City____________________________ State_______ ZIP________________ New location address_____________________________________ City____________________________ State_______ ZIP________________ Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete. ( ) Signature____________________________________________________________ Date________________ Telephone_____________________ ID number of preparer Preparer signature_____________________________________________________ Louisiana Department of Revenue • Post Office Box 3138 • Baton Rouge, LA 70821-3138 This return is due on or before the 20th day following the taxable period covered and becomes delinquent on the first day thereafter. If the due date falls on a weekend or holiday, the return is due the next business day and becomes delinquent the first day thereafter. Each physical location must register to obtain a separate Revenue Account ID. Final return Field flag FOR OFFICE USE ONLY. Enter date business sold/terminated. If amended return, mark this box. 4011 American LegalNet, Inc. www.FormsWorkFlow.com