Louisiana Form R 1376 – Fill Out and Use This PDF

R-1376 (2/98)

State of Louisiana

Department of Revenue

Certificate of Governmental Exemption from the Payment of Hotel Lodging Taxes

for use by employees of the government of the United States and the State of Louisiana

and its political subdivisions in documenting eligibility for exemption from payment of state sales

taxes on hotel lodging charges that are directly reimbursable by their government employers

This certifies that _____________________________________________________________________

Name and title of employee

is an employee of ____________________________________________________________________

Name of government employer

whose address and telephone number are ________________________________________________

	Street
(	)
________________________________________ _______________________________________
City, State, ZIP	Telephone
and that the lodging charges incurred by the employee at the	_________________________________
	Name of hotel

during the period _____________________________________________________________________

Dates of employee’s stay

are necessitated by the employee’s conduct of the official business of this government agency. The employee’s lodging expenses are required to be accounted for to his government agency employer and are reimbursable by the employer to the employee in the actual amount incurred. This government agency, therefore, claims exemption from the payment of lodging taxes on the charges for the occupancy of the employee’s hotel room.

____________________________________________________	_____________________________________________________	_______________________
Name and title of employee	Signature	Date
____________________________________________________	_____________________________________________________	_______________________
Name and title of other employee representative	Signature	Date

This form is usable only in documenting eligibility for exemption from the payment of state sales tax on charges for room occupancy. The state sales tax must be paid on other taxable purchases from the hotel, including meals, laundry, dry cleaning, and vehicle parking. When this form bears the signature of only the employee, the form must be accompanied by a copy of the employee’s written travel orders, in which the government employer directs a stay at the specific hotel accepting the form, or alternatively, at any hotel within a narrowly defined geographic area. The hotel must retain this certificate and a photocopy of the travel orders to document the exemption. This form is not valid to document exemption from the payment of local room occupancy taxes.