> R-1376 (2/98)![](media/image1.png){width="0.75625in"
> height="0.7527777777777778in"}
>
> 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.**