R-1376 (2/98)
State of Louisiana
Department of Revenue
Certificate of Governmental Exemption from the Payment of Hotel Lodging Taxes
for use by employees of the government of the United States and the State of Louisiana
and its political subdivisions in documenting eligibility for exemption from payment of state sales
taxes on hotel lodging charges that are directly reimbursable by their government employers
This certifies that _____________________________________________________________________
Name and title of employee
is an employee of ____________________________________________________________________
Name of government employer
whose address and telephone number are ________________________________________________
|
Street |
( |
) |
________________________________________ _______________________________________ |
City, State, ZIP |
Telephone |
and that the lodging charges incurred by the employee at the |
_________________________________ |
|
Name of hotel |
during the period _____________________________________________________________________
Dates of employee’s stay
are necessitated by the employee’s conduct of the official business of this government agency. The employee’s lodging expenses are required to be accounted for to his government agency employer and are reimbursable by the employer to the employee in the actual amount incurred. This government agency, therefore, claims exemption from the payment of lodging taxes on the charges for the occupancy of the employee’s hotel room.
____________________________________________________ |
_____________________________________________________ |
_______________________ |
Name and title of employee |
Signature |
Date |
____________________________________________________ |
_____________________________________________________ |
_______________________ |
Name and title of other employee representative |
Signature |
Date |
This form is usable only in documenting eligibility for exemption from the payment of state sales tax on charges for room occupancy. The state sales tax must be paid on other taxable purchases from the hotel, including meals, laundry, dry cleaning, and vehicle parking. When this form bears the signature of only the employee, the form must be accompanied by a copy of the employee’s written travel orders, in which the government employer directs a stay at the specific hotel accepting the form, or alternatively, at any hotel within a narrowly defined geographic area. The hotel must retain this certificate and a photocopy of the travel orders to document the exemption. This form is not valid to document exemption from the payment of local room occupancy taxes.