Form R-1024 "Designation of Construction Contractor as Agent of a Federally Recognized Indian Tribe and Exemption Certificate" - Louisiana

Form R-1024 is a Louisiana Department of Revenue form also known as the "Designation Of Construction Contractor As Agent Of A Federally Recognized Indian Tribe And Exemption Certificate". The latest edition of the form was released in October 1, 2016 and is available for digital filing.

Download an up-to-date fillable Form R-1024 in PDF-format down below or look it up on the Louisiana Department of Revenue Forms website.

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Download Form R-1024 "Designation of Construction Contractor as Agent of a Federally Recognized Indian Tribe and Exemption Certificate" - Louisiana

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R-1024 (10/16)
Designation of Construction Contractor as Agent of a Federally Recognized
Indian Tribe and Exemption Certificate
PLEASE PRINT OR TYPE.
_________________________________________________________________________, a federally recognized tribe, located within
Legal Name of Tribe
the boundaries of Louisiana, does hereby designate the following contractor as its agent for the purpose of making state sales tax exempt
purchases on behalf of the Tribe:
Name of Contractor
Address of Contractor
City
State
ZIP
This designation of agency shall be effective for purchases of component construction materials, taxable services, and leases and rent-
als of tangible personal property for the following named construction project located on the reservation or tribal lands designated for the
above named Tribe:
This designation and acceptance of agency is effective for the period _______________________ through ______________________.
Purchases for the named project during this period by the designated contractor shall be considered as the legal equivalent of purchases
directly by the Tribe. The designated agent must take delivery of materials and rental property on the designated reservation or trust lands,
and upon delivery, the materials become the property of the Tribe. The Tribe, as principal, assumes direct liability to the vendor for the pay-
ment of any property, services, leases, or rentals made by this designated agent. Materials must be for use or consumption exclusively
on the designated reservation or trust lands.
This agreement does not void or supersede the obligations of any party created under any construction contract related to this project,
including specifically any contractual obligation of the construction contractor to submit payment to the vendors of materials or services
for the project.
This contractor-agent is not authorized to delegate this purchasing agency to others; separate designations of agency by this Tribe are
required for each contractor or sub-contractor who is to purchase on behalf of the Tribe. The undersigned hereby certify that this designa-
tion is the entirety of the agency designation agreement between them. In order for a purchase for an eligible Tribe through a designated
agent to be eligible for state sales tax exemption, the designation of agency must be made, accepted, and disclosed to the vendor before
or at the time of the purchase transaction.
Under penalty of perjury, I declare that I have examined this exemption certificate and accompanying documents, and to the best of my
knowledge and belief, it is true, correct , and complete.
Designation of Agency by Tribe
Acceptance of Agency by Contractor
Signature of Authorized Designator
Date (mm/dd/yyyy)
Signature of Contractor or Subcontractor Authorized Acceptor
Date (mm/dd/yyyy)
Name of Authorized Designator (Please print.)
Name of Contractor’s or Subcontractor’s Acceptor (Please print.)
Name of Tribe
Name of Contractor
Address
Address
City
State
ZIP
City
State
ZIP
This designation of agency form, when properly executed by both the contractor and the Tribe, shall serve as evidence of the state sales
tax exempt status that has been conferred onto the contractor.
R-1024 (10/16)
Designation of Construction Contractor as Agent of a Federally Recognized
Indian Tribe and Exemption Certificate
PLEASE PRINT OR TYPE.
_________________________________________________________________________, a federally recognized tribe, located within
Legal Name of Tribe
the boundaries of Louisiana, does hereby designate the following contractor as its agent for the purpose of making state sales tax exempt
purchases on behalf of the Tribe:
Name of Contractor
Address of Contractor
City
State
ZIP
This designation of agency shall be effective for purchases of component construction materials, taxable services, and leases and rent-
als of tangible personal property for the following named construction project located on the reservation or tribal lands designated for the
above named Tribe:
This designation and acceptance of agency is effective for the period _______________________ through ______________________.
Purchases for the named project during this period by the designated contractor shall be considered as the legal equivalent of purchases
directly by the Tribe. The designated agent must take delivery of materials and rental property on the designated reservation or trust lands,
and upon delivery, the materials become the property of the Tribe. The Tribe, as principal, assumes direct liability to the vendor for the pay-
ment of any property, services, leases, or rentals made by this designated agent. Materials must be for use or consumption exclusively
on the designated reservation or trust lands.
This agreement does not void or supersede the obligations of any party created under any construction contract related to this project,
including specifically any contractual obligation of the construction contractor to submit payment to the vendors of materials or services
for the project.
This contractor-agent is not authorized to delegate this purchasing agency to others; separate designations of agency by this Tribe are
required for each contractor or sub-contractor who is to purchase on behalf of the Tribe. The undersigned hereby certify that this designa-
tion is the entirety of the agency designation agreement between them. In order for a purchase for an eligible Tribe through a designated
agent to be eligible for state sales tax exemption, the designation of agency must be made, accepted, and disclosed to the vendor before
or at the time of the purchase transaction.
Under penalty of perjury, I declare that I have examined this exemption certificate and accompanying documents, and to the best of my
knowledge and belief, it is true, correct , and complete.
Designation of Agency by Tribe
Acceptance of Agency by Contractor
Signature of Authorized Designator
Date (mm/dd/yyyy)
Signature of Contractor or Subcontractor Authorized Acceptor
Date (mm/dd/yyyy)
Name of Authorized Designator (Please print.)
Name of Contractor’s or Subcontractor’s Acceptor (Please print.)
Name of Tribe
Name of Contractor
Address
Address
City
State
ZIP
City
State
ZIP
This designation of agency form, when properly executed by both the contractor and the Tribe, shall serve as evidence of the state sales
tax exempt status that has been conferred onto the contractor.
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