PARISH OF ST. BERNARD SALES AND USE TAX DEPARTMENT					P.O. Box 168 CHALMETTE, LOUISIANA 70044
WARNING:			DO NOT use any other taxpayer’s return as this will result in improper credit
TO AVOID PENALTIES RETURN MUST BE TRANSMITTED ON OR BEFORE THE 20^TH DAY FOLLOWING THE PERIOD COVERED
						Make checks Payable to:
Account #						JACK A. STEPHENS Sheriff and Tax Collector
Business Name
Address
						Signature of owner officer or agent
City / State / Zip
SALES AND USE TAX DEPARTMENT 504-271-2504 SALES AND USE TAX RETURN
						Signature of preparer other than taxpayer
MONTH				YEAR
						Date
1.	GROSS SALES OF TANGIBLE PERSONAL PROPERTY
2.	LEASES, RENTALS, AND SERVICES
3.	COST OF TANGIBLE PERSONAL PROP (Used, consumed, stored for, use or consumption in ST. BERNARD PARISH)
4.	TOTAL OF ITEMS 1,2 AND 3
ALLOWABLE DEDUCTIONS
5.A.		SALES FOR RESALE
B.		SALES OUTSIDE OF ST. BERNARD PARSISH
C.		SALES FOR FURTHER MANUFACTURE
D.		SALES TO THE UNITED STATES GOVERNMENT
E.		CASH DISCOUNTS, SALES RETURNS AND ALLOWANCES
F.		SALES IN INTERSTATE COMMERCE
G.		FERTILIZER, INSECTICIDES, FUNGICIDES, PESTICIDES,AND SEED SOLD DIRECT TO FARMERS
H.		SALES OF GASOLINE (Special fuels if 20 cent road tax has been paid)
I.		ANY OTHER DEDUCTIONS AUTHORIZED BY LAW (Itemize)
J.		TOTAL ALLOWABLE DEDUCTIONS (Enter at item 6)
6.	LESS ALLOWABLE DEDUCTIONS (Item 5A through I)
7.	AMOUNT TAXABLE (Item 4 minus Item 6)
8.
9.	EXCESS TAX COLLECTED
10.	TOTAL (Item 8 plus Item 9)
11.	VENDOR’S COMPENSATION
12.	AMOUNT TAX DUE (Item 10 minus Item 11)
13.	TAX DEBIT OR CREDIT (Authorized memo must be attached)
14.	DELINQUENT PENALTY (5% of Tax for each 30 days or fraction thereof of delinquency, not to exceed 25% of the aggregate)
15.	INTEREST: (15% per annum from due date until paid)
16.	TOTAL TAX, PENALTY AND INTEREST DUE
I declare under the penalties for filing false reports that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge is a true, correct, and complete return. If the return is prepared by a person other than the taxpayer, his declaration is based on all the information relating to the matters required to be reported in the return of which he has any knowledge.