Louisiana Natural Disaster Claim for Refund of State Sales Taxes Paid

Natural Disaster Claim for Refund of State Sales Taxes Paid
Form R-1362
R-1362 (9/21)

Natural Disaster Claim for Refund of State
Sales Taxes Paid

Return completed form to:
Louisiana Department of Revenue
P.O. Box 91138
Baton Rouge, LA 70821-9138

Must attach Form R-1362S, Calculation of State Sales Tax Refund Due and Form R-1362D, Schedule of Tangible Personal
Property Destroyed by a Natural Disaster
Louisiana Revised Statute 47:315.1 provides a state sales tax refund for property destroyed by a natural disaster in a parish that has
been declared, by the President of the United States, eligible for federal assistance. Taxpayers may use this form to claim a refund
only if the loss was not fully reimbursed by insurance or other federal assistance. The destroyed property must have been held for
personal use at the taxpayer’s primary residence.
PLEASE PRINT OR TYPE
Claimant’s Name

DOB (mm/dd/yyyy)

Social Security Number

Spouse’s Name

DOB (mm/dd/yyyy)

Spouse’s Social Security Number

■

Mailing Address

Check box to indicate address change

Resident of Louisiana Since (mm/yyyy)

City

State

ZIP

Telephone (Daytime)

Email Address

Location and Description of Destruction
Street Address (including apartment number)

Parish

City

Date of Disaster (mm/dd/yyyy)

Primary Cause of Destruction:

■ Flood

ZIP

■ Wind

Name or Description of Disaster

Type of Home:

■ Other_________________________

■ House

■ Apartment/Condo

■ Mobile Home
Total Number of Areas
that Received Damage

Area(s) of the home that received damage:
■ Kitchen

■ Living Room

■ Dining Room

■ Bedroom(s) (how many rooms) ______

■ Breakfast Area

■ Den

■ Garage/Carport

■ Bathroom(s) (how many rooms) ______

■ Patio

■ Outdoor Structure

■ Other ______________

1 Total amount of unreimbursed property loss from Form R-1362S, Line 3, Total Column.

$

2 Total amount of state sales tax requested to be refunded from Form R-1362S, Line 6, Total Column.

$

Print Preparer’s Name

Preparer’s Signature

Date (mm/dd/yyyy)
Check

PAID
PREPARER
USE ONLY

Firm’s Name

➤

Firm’s FEIN

➤

Firm’s Address

➤

Telephone

➤

■

if Self-employed

PTIN, FEIN, or LDR Account Number
of Paid Preparer
For Office
Use Only.

Page 1 of 4

R-1362 (9/21)

Natural Disaster Claim for Refund of State
Sales Taxes Paid

Return completed form to:
Louisiana Department of Revenue
P.O. Box 91138
Baton Rouge, LA 70821-9138

Certified Statement of Natural Disaster Refund Claim
The aforesaid individual, being duly sworn, deposes and says that the following statement is true and correct, that he is entitled to the
refund requested, and that he is not delinquent with the State of Louisiana in the payment of any state taxes.
The property described on the schedule was destroyed by a natural disaster in a “natural disaster area” so declared by the President
of the United States. I hereby certify:
•	 That the destroyed property was held for personal use at my residence, was not owned by a business, partnership, or
corporation, and was not otherwise used by any person for commercial purposes;
•	 That the property was movable, both at the time of its purchase and at the time of its destruction;
•	 That I paid the Louisiana state sales/use tax on my purchase of the destroyed property in the amounts now requested to
be refunded, and that the property was not acquired by gift, purchased outside the state, or otherwise without payment by
me of the Louisiana sales/use tax; and,
•	 That all expected and actual reimbursements from insurance and other sources have been included.
Natural disaster refund claims must be notarized to be processed. Filing or submitting false information or false representation
on this refund claim may result in jail time of 5 years and/or fines up to $5,000 under Louisiana Revised Statute 14:133.
SWORN TO AND SUBSCRIBED BEFORE ME THIS ______________________________ day of ____________________,

__________

	year

Claimant’s Name (please print)

Claimant’s Signature

Spouse’s Name (please print)

Spouse’s Signature

Paid Preparer Name if other than taxpayer (please print)

Signature of Paid Preparer

Paid Preparer Telephone Number

Notary Name (please print)

Notary Signature

Notary Number

Page 2 of 4

R-1362S (9/21)

Natural Disaster Claim for Refund
Calculation of State Sales Tax Refund Due

Must be attached to Natural
Disaster Claim for Refund of State
Sales Taxes Paid – Form R-1362

PLEASE PRINT OR TYPE
Claimant’s Name

Social Security Number

Spouse’s Name

Spouse’s Social Security Number

Calculation of State Sales Tax Refund Due
R-1362D, Column A
4% tax rate
1

Total cost of destroyed property from attached Form(s) R-1362D

2

Reimbursement of destroyed property

2a

Reimbursement from insurance – actual or anticipated

■

		Check box if destroyed property was not covered by insurance.

R-1362D, Column B
5% tax rate

R-1362D, Column C
4.45% tax rate

TOTAL
(Column A + B +C)

$

$

$

$

($	)

($	)

($	)

($	)

($	)

($	)

($	)

($	)

Reimbursement from employer or disaster relief agencies
2b

	 	Check box if you were denied reimbursement from an employer.
■ 	 	Check box if you were denied reimbursement from any disaster
■

relief agencies, including FEMA.
2c

Total reimbursement – Add Lines 2a and 2b for Columns A, B, and C.

($	)

($	)

($	)

($	)

3

Total unreimbursed property loss – Subtract Line 2C from Line 1 for
Columns A, B, and C.

$

$

$

$

4

State sales tax rate

5

State sales tax computation – Multiply Line 3 by the sales tax rates
found on Line 4 for Columns

6

Total state sales tax refund requested. Add Line 5, Columns A, B,
and C.

4%
$

5%
$

4.45%
$
$

Page 3 of 4

R-1362D (9/21)

NATURAL DISASTER CLAIM FOR REFUND
Schedule of Tangible Personal
Property Destroyed by a Natural Disaster

Must be attached to Natural
Disaster Claim for Refund of State
Sales Taxes Paid – Form R-1362

PLEASE PRINT OR TYPE
Claimant’s Name

Social Security Number

Spouse’s Name

Spouse’s Social Security Number

See Form R-1362i, Natural Disaster Claim for Refund Instructions, for guidance on how to complete this form and examples of qualifying items. To support your claim, you must also
attach the Proof of Loss Documentation described in the instructions.

Description of Property
Destroyed

Date of
Purchase
(mm/dd/yyyy)

COLUMN A

COLUMN B

COLUMN C

Original Cost of Property
Purchased PRIOR TO
APRIL 1, 2016

Original cost of Property
Purchased BETWEEN
APRIL 1, 2016 – June 30, 2018

Original cost of Property
Purchased ON or AFTER
JULY 1, 2018

Total Property Cost (Total columns A, B, and C.)
If more space is needed, additional copies of this form may be used.

Page 4 of 4