1.Gross sales of Tangible Personal Property, Leases, Rentals and Services as

Sales of Food Paid for with USDA Food Stamps or WIC Vouchers

Sales to the U.S. Govt. , the State of LA, its Political Subdivisions and AgenciesSales of Gasoline or Motor Fuels

Sales Delivered or Shipped Outside this Jurisdiction (Does not apply to Repairs)

Cash Discounts, Sales Returns & Allowances

Sales for Resale or Further Processing (Certificate on File)

OTHER DEDUCTIONS AUTHORIZED BY LAW (EXPLAIN BRIEFLY)

Reported to the State of Louisiana

12.11.10.9.8.

7.6.5.4.3.2.

1.

(LINE 18 MINUS LINE 19)

13.14.15.16.17.18.19.20.21.22.23.24.25.

Thereof of Delinquency not to exceed 25%5% of Tax for Each 30 days or Fraction of MonthDelinquent Penalty

NET TAX DUE

TOTAL (Line 16 Plus Line 17)EXCESS TAX COLLECTED

Tax Due - Multiply Line 15 by % Shown in Column

TOTAL (Line 13 Plus Line 14)

13.14.15.16.17.18.19.20.21.22.23.24.25.

TOTAL ALLOWABLE DEDUCTIONS (Line 2 thru 10)ADJUSTED GROSS SALES (Line 1 MINUS Line 11)

DEDUCTIBLE ONLY WHENPAYMENT IS NOT DELINQUENT

Purchases Subject to Use Tax In Each Jurisdiction

TOTAL AMOUNT DUE (LINE 23 PLUS OR MINUS LINE 24)

(AUTHORIZED MEMO MUST BE ATTACHED)TAX DEBIT OR CREDIT

Total Tax, Penalty and Interest Due (Line 20 Plus Lines 21 & 22)

Interest 1 1/4% Per Month

Vendor Compensation 1% OF LINE 18

11.

Adjusted Gross Sales in Each Jurisdiction Total of ColumnsMust Equal Line 12

Account #

MONTH:

AUDITED BY

STATE TAX I.D. #

TOTAL OF COLUMNS A + B + C + D + E LINE 26.

DATE

SIGNATURE OFINDIVIDUALOR AGENT

DISHONOREDCHECK CHARGE

WHICHEVERIS GREATER1% OF THE CHECK OR $20

TOTAL REMITTED

$

COMPLETE ONLY THOSE COLUMNS IN WHICH TAXABLE ACTIVITY OCCURS

OFFICE USE ONLY

IBERIA PARISH SCHOOL BOARD

P. O. BOX 9770 • NEW IBERIA, LA 70562-9770Phone: (337) 365-2341 • Fax: (337) 365-6584

SALES TAX INFO: WWW.LAOTA.COM

ALLOWABLE DEDUCTIONS

Computation of Sales and Use Tax

A. B. C. D. E.4 1/2% 4 1/2% 3 3/4% 4 1/4% 3 1/4%

City of New IberiaIberia Parish School Board

Parish Gov. MosquitoLaw Enforcement Dist.

City of JeaneretteIberia Parish School Board

Parish Govt. MosquitoParish Govt. RecreationLaw Enforcement Dist.

Town of DelcambreIberia Parish School Board

Parish Govt. MosquitoParish Govt. RecreationLaw Enforcement Dist.

Village of LoreauvilleIberia Parish School Board

Parish Govt. MosquitoParish Govt. RecreationLaw Enforcement Dist.

Iberia Parish School BoardParish Govt. Mosquito

Parish Govt. RecreationParish Govt. GarbageLaw Enforcement Dist.

Date Due Until PaidCalculated Daily @ .000411 From

This return DUE on the 1st day of the month following the period covered by thisreturn, and becomes DELINQUENT if not transmitted on or before the 20th day.

Change in Name of Business

Name of Purchaser

Mailing Address Change

Date Business Sold

Business Location Change

Date Business Discontinued

Remittances Payable to: Iberia Parish Sales & Use Tax Department

SALES & USE TAX DEPT.