R 1042 Louisiana Certificate – Fill Out and Use This PDF

R-1042 (10_08)

Louisiana Resale Certificate

Sales Tax Exemption

Certificate for Purchases for Resale

R.S. 47:301(10)

Please print or type.

Purchaser’s Type of Business

Description of purchaser’s business activity or items sold:

I, the purchaser, certify that all materials, goods, merchandise, and services purchased from the seller named below are for resale as tangible personal property, either in the same form as purchased or to be added as a recognizable, identifiable, and beneficial component of a new product. I further certify that all tax-exempt purchases will be resold in the normal course of our business.

I understand that if I use any of the items other than for resale, I must pay sales tax at the time of use. If this purchase is later found to be subject to tax, I, the purchaser, assume full liability for the tax.

Seller Information

Seller

Address (Street & number or P.O. Box)

Any purchaser or agent who fraudulently signs this certificate without intent to use the taxable items for resale is subject to all the penalties provided for by Title 47 of the Louisiana Revised Statutes and collection will be pursued against the seller or purchaser for any taxes, penalties and interest due.

Purchaser’s Declaration