Fill and Sign the Contract Completion Form

R-1341 (7/98) State of Louisiana Department of Revenue Instructions for Contract Completion Form General Instructions This form is required to be completed prior to the release of any surety bond obtained for any contract engaged in by a nonresident contractor, as defined in Louisiana Revised Statute 47:9. Failure to properly complete this form will delay the release or reduction of any bond now held by the Secretary of the Department of Revenue. Prior to the release or reduction of any bond, verification of tax payment and/or settlement of any tax liability will be requested from all affected taxing authorities, including but not limited to, city and parish sales/use tax authorities; Department of Labor; Office of Employment Security; and related tax sections within the Department of Revenue. Verification that no tax is due by your company to the affected taxing authorities will result in the release or reduction of the bond. The bond cannot be terminated or reduced without written approval by the Secretary of the Department of Revenue. A separate contract completion form must be completed for each contract. Line Instructions 1. Contractor/Subcontractor name – List the name(s) of the person(s) or corporation to whom the contract was let. 2. Mailing address – All information concerning the identified contract will be mailed to this address. 3. Representative name and telephone number – List name and telephone number of a contact person if questions should arise concerning this form. 4. Description and location of facility altered, renovated, or erected – This information should specifically identify the contract for which this form is being completed. Refer to Section B, Line 1 of Form R-1342, Tax Registration Number and Contract Information Form. Also include beginning and ending dates of contract. 5. Original estimated contract amount – This is the estimated contract amount to the person(s) or corporation for whom this specific contract was performed. 6. Actual contract amount (if different from Line 5) – This is the entire contract amount charged by your company, (including any change orders) to the person(s) or corporation for whom this specific contract was performed. 7. Amount awarded to subcontractors – This is the amount of the contract that was not performed by your company. A resident contractor is one that is located within the State of Louisiana. A nonresident contractor is one that is normally located outside Louisiana. An updated list of subcontractors should also be provided. 8. Construction materials cost – This amount should include the cost of all materials used by your company that became a component part of the facility whether purchased in this state or brought into this state for use in the performance of the contract. (Do not include taxes paid.) 8a. Cost of materials purchased out of state – List that portion of the amount shown on Line 8 that was the cost of materials purchased out of state and on which sales tax was paid to another state. (Do not include taxes paid.) 8b. Tax paid to another state on Line 8a – This is the amount of sales tax paid on the material cost listed on Line 8a for which reciprocal credit was claimed. List the state to which this tax was paid and the rate at which it was paid. (If more than one rate, attach itemized schedule.) 9. Equipment cost – This amount should include the cost of tools, supplies, and equipment necessary for the performance of the contract. This includes anything that did not become a component part of the contract. (Do not include taxes paid.) 9a. Cost of equipment purchased out of state – List that portion of the amount shown on Line 9 on which another state’s sales tax was paid. (Do not include taxes paid.) 9b. Tax paid to another state on Line 9a – This is the amount of tax paid on purchases listed on Line 9a for which reciprocal credit was claimed. List the state to which the sales tax was paid and the rate. (If more than one rate, attach itemized schedule.) 10. Equipment rentals – This amount should include all rentals of tangible personal property. 10a. Tax paid to another state on Line 10 – This is the amount of tax paid on rentals listed under Line 10 for which reciprocal credit was claimed. List the state to which the sales tax was paid and the rate. (If more than one rate, attach itemized schedule.) 11. Total Louisiana tax (state and local) paid on construction materials, equipment, and rentals – This amount should include total state and local sales/use tax paid (not including those amounts paid to another state shown on Lines 8b, 9b and 10a). This amount should include taxes paid directly to vendors and use tax remitted directly to the state. (Line 11 should equal Line 12 plus Line 13.) 12. Total Louisiana state tax paid on construction materials, equipment, and rentals – This amount is that portion of Line 11 that represents Louisiana state sales/use paid. (Line 12 should equal Line 14 plus Line 16.) 13. Total Louisiana local tax paid on construction materials, equipment, and rentals (total of city, parish, police jury, school board, etc.) – This amount equals that portion of Line 11 that represents Louisiana local sales/use taxes paid. (Line 12 should equal Line 15 plus Line 16.) 14. Amount of tax paid directly to the State of Louisiana – This amount should reflect the state sales tax accrued and paid directly to the State of Louisiana and the account number under which it was paid. 15. Amount of tax paid directly to the local taxing authorities – This amount should reflect the total amount of tax remitted to any local taxing authorities in Louisiana. Identify each authority to whom the tax was remitted and the account number under which it was paid. 16. Amount of tax paid to vendors – This is the amount of Louisiana sales tax paid directly to your suppliers on purchases of materials, equipment, rentals, and supplies necessary to perform the job. The amount of state sales tax paid to your suppliers should be separated from the amount of local tax and the correct fiure should be listed under the respective headinis. 17. Gross payroll – This amount is the total amount of Louisiana state income tax withheld and reported to this Department for the gross payroll for this project. This figure does not include federal income tax withheld nor does this figure include other states’ income tax on income earned in another state. If no Louisiana tax was withheld, please explain. 17a. State income tax withheld – Please identify the month and year in which this payroll began and ended and the account number under which the tax was paid. 18. Corporation franchise tax account number – List account number and name under which franchise tax (if any) was paid. 18a. Estimated franchise taxable base (if any) – This amount is determined as follows: $1.50 per $1,000 of the first $300,000 of capital stock surplus, undivided profits, and borrowed capital allocated to Louisiana, plus $3 per $1,000 of capital stock, surplus, undivided profits, and borrowed capital allocated to Louisiana in excess of $300,000. The allocation formula is based on the arithmetical average of: (1) ratio of net sales and other revenue attributable to Louisiana to total, and (2) ratio of the value of tangible and intangible assets located in Louisiana to total. Taxable base shall not be less than the assessed value of real and personal property located in Louisiana. Minimum tax is $10. 18b. Income tax account number (if corporation) – Any nonresident and any individual who was a resident for part of the year and a nonresident the remainder of the year must report his income from all sources for the period during which he was a resident, plus all income from Louisiana sources for the period he was a nonresident. Any corporation deriving income from Louisiana sources must be registered and must file required returns. List account number if business is incorporated. 18c. Social Security Number – List social security number if business owner is individual. 18d. Account name – List the account name under which taxes were paid. 18e. Estimated tax payments (if corporation) – List estimated tax payments made to this Department during the period in which the contract was ongoing. 18f. Estimated net income from contract – Estimated net income from this contract only should be listed in the space provided. 19. Louisiana unemployment insurance account number – As a business employing persons in this state, you are responsible for the payment of this tax. Please give the account number assigned to you for remittance of this tax. 19a. Federal Identification Number – Please furnish your Federal Identification Number under which federal taxes are remitted. If you are not liable for this tax, please indicate. R-1341A (1/02) State of Louisiana Department of Revenue Contract Completion Form 1. Contractor/Subcontractor Name 2. Mailing address City, State, ZIP 3. Representative name Telephone 4. Description and location of facility altered, renovated, or erected Description (type of building, name, etc.) Location (street, city, and parish) Beginning date 5. Original estimated contract amount Ending date 6. Actual contract amount (if different from Line 5) 7. Amount awarded to subcontractors Resident $ Nonresident $ Please provide updated list of subcontractors. (See Form R-1130-L, General Contractor/Subcontractor List.) Sales and Use Tax 8. Construction materials cost (Do not include taxes paid.) 8a. Cost of materials purchased out of state (Do not include taxes paid.) 8b. Tax paid to another state on 8a Tax amount Rate State 9. Equipment cost (Do not include taxes paid.) 9a. Cost of equipment purchased out of state (Do not include taxes paid.) 9b. Tax paid to another state on 9a Tax amount Rate State 10. Equipment rentals 10a. Tax paid to another state on 10 Tax amount Rate State 11. Total Louisiana tax (state and local) paid on construction materials, equipment, rentals 12. Total Louisiana state tax paid on construction materials, equipment, rentals 13. Total Louisiana local tax paid on construction materials, equipment, rentals (total of city, parish, police jury, school board, etc.) 14. Amount of tax paid directly to the State of Louisiana Account number 15. Amount of tax paid directly to the local taxing authorities (Please identify to whom the tax was paid.) Authority Account number Amount Authority Account number Amount Authority Account number Amount 16. Amount of tax paid to vendors State Local Job number Bond number Release date State Income Tax Withholdini 17. Gross payroll $ If no Louisiana tax withheld, please explain. Louisiana tax withheld 17a. State income tax withheld Period (beginning month/year through ending month/year) Account number (10-digit number) Corporation Income Franchise/Individual Income Tax 18. Corporation franchise tax account number 18a. Estimated franchise taxable base 18b. Income tax account number (if corporation) 18c. Social Security Number (if individual) 18d. Account name 18e. Estimated tax payments 18f. Estimated net income from contract Unemployment Insurance Tax 19. Louisiana unemployment insurance account number 19a. Federal Identification Number The undersigned certifies that the above is a complete and accurate statement of liabilities incurred and payments made for the Louisiana state and local taxes indicated, pursuant to the contract identified above. ____________________________________________________________ Authorized signature Date: ____________________________________________________________ Notary public Date