Form R-1349 Pollution Control Equipment Sales/Use Tax Exemption/Refund Application - Louisiana

Form R-1349 or the "Pollution Control Equipment Sales/use Tax Exemption/refund Application" is a form issued by the Louisiana Department of Revenue.

The form was last revised in February 1, 2013 and is available for digital filing. Download an up-to-date fillable Form R-1349 in PDF-format down below or look it up on the Louisiana Department of Revenue Forms website.

ADVERTISEMENT
R-1349 (2/13)
Page 1 of ___
Louisiana Department of Revenue
Pollution Control Equipment
Office Audit Division
Sales/Use Tax Exemption/Refund Application
P.O. Box 3863
Louisiana Revised Statute 47:301(10)(l)
Baton Rouge, LA 70821
Louisiana Department of Revenue (LDR)
Received by LDR ________ Received by ________
Louisiana Department of Environmental Quality (DEQ)
Received by DEQ ________ Received by ________
PART 1: To be completed by applicant
Facility Name:
LDR Sales Tax Account Number:
Refund Tax Periods:
Legal Name:
(mm/dd/yyyy to mm/dd/yyyy) ________________ to ________________
Physical Address of Facility
Mailing Address of Facility (if different from physical address)
Street Address:
Address:
City/State/Zip Code:
City/State/Zip Code:
Parish:
Parish:
Contact Person:
Contact Person:
Position:
Position:
Contact Email Address:
Contact Email Address:
Telephone Number:
Telephone Number:
Fax Number:
Fax Number:
Is this application for (choose one):
Pre-Purchase Exemption
Post-Purchase Refund
Name of Project:
_______________________________________________________________________________________
Estimate the pounds of emissions per year to be reduced and/or the efficiency of the purchased equipment.
Equipment Efficiency:
Projected reduction in pounds of TRI:
Projected reduction in pounds of criteria air emissions
Other (Explain):
R-1349 (2/13)
Page 1 of ___
Louisiana Department of Revenue
Pollution Control Equipment
Office Audit Division
Sales/Use Tax Exemption/Refund Application
P.O. Box 3863
Louisiana Revised Statute 47:301(10)(l)
Baton Rouge, LA 70821
Louisiana Department of Revenue (LDR)
Received by LDR ________ Received by ________
Louisiana Department of Environmental Quality (DEQ)
Received by DEQ ________ Received by ________
PART 1: To be completed by applicant
Facility Name:
LDR Sales Tax Account Number:
Refund Tax Periods:
Legal Name:
(mm/dd/yyyy to mm/dd/yyyy) ________________ to ________________
Physical Address of Facility
Mailing Address of Facility (if different from physical address)
Street Address:
Address:
City/State/Zip Code:
City/State/Zip Code:
Parish:
Parish:
Contact Person:
Contact Person:
Position:
Position:
Contact Email Address:
Contact Email Address:
Telephone Number:
Telephone Number:
Fax Number:
Fax Number:
Is this application for (choose one):
Pre-Purchase Exemption
Post-Purchase Refund
Name of Project:
_______________________________________________________________________________________
Estimate the pounds of emissions per year to be reduced and/or the efficiency of the purchased equipment.
Equipment Efficiency:
Projected reduction in pounds of TRI:
Projected reduction in pounds of criteria air emissions
Other (Explain):
R-1349 (2/13)
Page 2 of ___
Applicant Name: __________________________________ LDR Sales Tax Account Number: _______________________________
Pollution Control Equipment and Process Description
Instructions: Give a detailed description of the pollution control equipment with an explanation of the function of each component in
the process. The description must include a process flow diagram which identifies the equipment location in the flow diagram. Please
provide proof of a net decrease in the volume, toxicity or potential hazards of pollution and/or the citation of the federal or state envi-
ronmental law or regulation which requires installation of the pollution control equipment.
R-1349 (2/13)
Page 3 of ___
Applicant Name: __________________________________ LDR Sales Tax Account Number: _______________________________
Major Equipment Components
Name/Type of Major Component
Description of Equipment and Use in Pollution Control Project
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Attach additional sheets if necessary.
R-1349 (2/13)
Page 4 of ___
PART 2: Certification of Professional Engineer
I certify that I am familiar with the intent of Act No. 1019 of the 1991 Regular Session of the Louisiana Legislature and the rules and
regulations in Title 47. I have reviewed the application and concur that all items listed are major and integral components of the pollution
control device or system, as defined in the Act, and are used exclusively for pollution control. Furthermore, I certify that, either (1) a net
decrease in the volume, toxicity or potential hazards of pollution will result from the installation of the device or system; or (2) installation
is necessary to comply with federal or state environmental laws or regulations. This certification includes visiting the site, if applicable,
and confirming that the equipment is installed properly and is meeting the efficacy for which the service is intended. I understand there
are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Name:
Title:
Signature:
Date:
Louisiana Professional Engineer License Number:
Applicant Name: __________________________________ LDR Sales Tax Account Number: _______________________________
PART 3: Certification of Applicant
This application must be signed by a corporate officer, board member or person having authority to bind the entity making the application.
Verification of the representative’s authority to sign on behalf of the entity may be required in the form of a properly executed Power of
Attorney and Declaration of Representative.
Under the penalties of perjury, I declare that I am authorized to sign this application on behalf of the above named entity and, to the best
of my knowledge, this application is true, correct, and complete.
Name:
Title:
Signature:
Date:
R-1349 (2/13)
Page 5 of ___
PART 4: To be completed by DEQ
Acting as an authorized representative of the Secretary of the Louisiana Department of Environmental Quality, I certify that I have
examined the application listed above, for the applicant ________________________________(applicant name), and have determined
that the pollution control device or system for which approval is indicated in Part 1 meets the efficacy requirement intended in Act 1019,
and therefore, is eligible for the sales and use tax exemption under R.S. 47:301(10)(l). The original signed, certified application shall be
submitted to the Louisiana Department of Revenue.
Name:
Title:
Signature:
Date:
PART 5: To be completed by LDR
Louisiana Department of Revenue approval
Exemption
Refund (choose one) is hereby
Based upon a review of the information submitted with this application, the request for
approved for those items that have DEQ approval, as indicated in Part 1.
Name:
Title:
Signature:
Date:
Confidentiality: This application, including cost information, is considered a confidential document in accordance with Louisiana Revised Statute
47:1508. Information that pertains to pollution control devices and system costs will be maintained only at the Louisiana Department of Revenue.

Download Form R-1349 Pollution Control Equipment Sales/Use Tax Exemption/Refund Application - Louisiana

770 times
Rate
4.5(4.5 / 5) 39 votes
ADVERTISEMENT
Page of 9