United Health Care Form PDF Details

The United Health Care form, known officially as R-1042 (revision date 10/08), serves as a critical document for businesses within Louisiana looking to purchase goods tax-free for the purpose of resale. This form, recognized as a Resale Certificate or Sales Tax Exemption Certificate, is governed by Louisiana Revised Statutes section 47:301(10), demanding meticulous completion to validate eligibility for tax exemption. Essential details required on this form include the purchaser's name as it appears on the sales tax account, a 10-digit sales tax account number, along with the business address, telephone number, and a detailed description of the buyer's business activities or the items intended for resale. It requires a declaration from the purchaser, certifying that all items bought from the seller will be resold in the form of tangible personal property, either unchanged or as part of a new product, thereby making these purchases exempt from sales tax at the point of sale. The form emphasizes the legal obligation of the purchaser to pay sales tax on any items not used for resale purposes. It also includes a stern warning about fraudulent use of the certificate, highlighting the potential for penalties, including tax liabilities, fines, and interest, as stipulated by Louisiana law. This comprehensive document underscores the importance of transparency and honesty in business transactions, offering a pathway for legitimate tax exemption on qualifying purchases.

QuestionAnswer
Form NameUnited Health Care Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesunited health care enrollment, united enrollment form, united care enrollment, united employee enrollment form

Form Preview Example

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 Information

 

 

 

 

 

 

 

 

 

Name of purchaser, as shown on the sales tax account

 

Sales Tax Account Number (10 digits)

 

 

 

 

 

 

 

Address

 

 

Telephone

 

 

 

(

)

 

 

 

 

 

 

 

 

 

City

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

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)

City

State

ZIP

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

Name

Signature

X

Title

Date (mm/dd/yyyy)

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Note the information in Address Street number or PO Box, City, State, ZIP, Any purchaser or agent who, Name, Signature X, Purchasers Declaration, Title, and Date mmddyyyy.

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