Form R-1069 "Application for Certification as a Paper or Wood Products Manufacturing Facility to Qualify for the Sales Tax Exclusion for Electric Power or Energy, or Natural Gas" - Louisiana

What Is Form R-1069?

This is a legal form that was released by the Louisiana Department of Revenue - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Louisiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form R-1069 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Revenue.

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Download Form R-1069 "Application for Certification as a Paper or Wood Products Manufacturing Facility to Qualify for the Sales Tax Exclusion for Electric Power or Energy, or Natural Gas" - Louisiana

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R-1069 (8/16)
Application for Certification as a Paper or Wood Products
Mail to:
Manufacturing Facility to Qualify for the Sales Tax
Louisiana Department of Revenue
Revenue Processing Center
Exclusion for Electric Power or Energy, or Natural Gas
P.O. Box 4998
Revised Statute 47:301(3)(j) and (13)(m)
Baton Rouge, LA 70821-4998
Part 1
Legal Name
Trade Name
Location Address
City
State
ZIP
Mailing Address
City
State
ZIP
Contact Person
Telephone Number
Part 2
Louisiana Department of Revenue Account Numbers
(List the account numbers for which this business is registered)
Businesses not registered for sales tax must file a CR-1, Application for Louisiana Sales Tax Account Number (R-16019), with this application.
Sales Tax Account Number
Withholding Tax Account Number
Corporate Income/Franchise Tax Account Number
Part 3
Louisiana Workforce Commission
Is this business required to register with the Louisiana Workforce Commission?
Yes
No
(If you answered no to this question, go directly to Part 4.)
Louisiana Workforce Commission Employer Account File Number:
(Contact the Louisiana Workforce Commission at (225) 342-3160 for assistance.)
North American Industry Classification System (NAICS) Code issued by the LA Workforce Commission:
(Use the NAICS code issued to this location from the Multiple Worksite Report if this is a separate location.)
(If you answered yes to the question above, go directly to Part 5.)
Part 4
Businesses that are not required to register with the Louisiana Workforce Commission must provide the Business Activity Code
Number listed on the most recently filed federal income tax return and include a copy of the federal form that shows this number.
Business Activity Code: ________________________ Form submitted: ________________________
New businesses that have not filed a federal income tax return prior to filing this application must submit a signed affidavit stating
the company’s primary business activity according to the North American Industry Classification System.
Part 5
Description of Business:
(Attach additional sheet(s) if necessary.)
Finished Goods Produced:
Qualifying purchases are subject to state sales tax at rates as shown in the box below.
Applicable State Sales Tax Rates
From
To
Rate
Exemption Code
4/1/2016
6/30/2016
5%
1010
7/1/2016
6/30/2018
3%
1010
7/1/2018
3/31/2019
0%
1010
Under penalty of perjury, I declare that I have examined this application for exemption and accompanying documents, and to the best of my
knowledge and belief it is true, correct, and complete.
Signature of Owner/Officer
Title
Date
(mm/dd/yyyy)
FOR OFFICIAL USE
Signature of Department Representative
Date
(mm/dd/yyyy)
Approved
Disapproved
R-1069 (8/16)
Application for Certification as a Paper or Wood Products
Mail to:
Manufacturing Facility to Qualify for the Sales Tax
Louisiana Department of Revenue
Revenue Processing Center
Exclusion for Electric Power or Energy, or Natural Gas
P.O. Box 4998
Revised Statute 47:301(3)(j) and (13)(m)
Baton Rouge, LA 70821-4998
Part 1
Legal Name
Trade Name
Location Address
City
State
ZIP
Mailing Address
City
State
ZIP
Contact Person
Telephone Number
Part 2
Louisiana Department of Revenue Account Numbers
(List the account numbers for which this business is registered)
Businesses not registered for sales tax must file a CR-1, Application for Louisiana Sales Tax Account Number (R-16019), with this application.
Sales Tax Account Number
Withholding Tax Account Number
Corporate Income/Franchise Tax Account Number
Part 3
Louisiana Workforce Commission
Is this business required to register with the Louisiana Workforce Commission?
Yes
No
(If you answered no to this question, go directly to Part 4.)
Louisiana Workforce Commission Employer Account File Number:
(Contact the Louisiana Workforce Commission at (225) 342-3160 for assistance.)
North American Industry Classification System (NAICS) Code issued by the LA Workforce Commission:
(Use the NAICS code issued to this location from the Multiple Worksite Report if this is a separate location.)
(If you answered yes to the question above, go directly to Part 5.)
Part 4
Businesses that are not required to register with the Louisiana Workforce Commission must provide the Business Activity Code
Number listed on the most recently filed federal income tax return and include a copy of the federal form that shows this number.
Business Activity Code: ________________________ Form submitted: ________________________
New businesses that have not filed a federal income tax return prior to filing this application must submit a signed affidavit stating
the company’s primary business activity according to the North American Industry Classification System.
Part 5
Description of Business:
(Attach additional sheet(s) if necessary.)
Finished Goods Produced:
Qualifying purchases are subject to state sales tax at rates as shown in the box below.
Applicable State Sales Tax Rates
From
To
Rate
Exemption Code
4/1/2016
6/30/2016
5%
1010
7/1/2016
6/30/2018
3%
1010
7/1/2018
3/31/2019
0%
1010
Under penalty of perjury, I declare that I have examined this application for exemption and accompanying documents, and to the best of my
knowledge and belief it is true, correct, and complete.
Signature of Owner/Officer
Title
Date
(mm/dd/yyyy)
FOR OFFICIAL USE
Signature of Department Representative
Date
(mm/dd/yyyy)
Approved
Disapproved