DECLARATION OF RESIDENCY

Louisiana residency shall be established if in exchange for employment with a motion picture production company. The
individual agrees in writing to file Form IT-540, as a full-year Louisiana resident, or Form IT-540B, as a part-year
Louisiana resident, for his taxable year employed by the motion picture production company and to pay the Louisiana
income tax shown thereon.  

Name of Production:    “Robosapien”

Production Company: Rebooted Productions, LLC


Employee’s Name:

___________________________________________________________

Social Security Number:

___________________________________________________________

Louisiana Drivers License/Identification Number (if available):

___________________________________________________________

Address:

___________________________________________________________

City, State, Zip:

___________________________________________________________

Job Title:

___________________________________________________________

I hereby certify that I am currently a resident of the State of Louisiana, and will continue to be a resident during the
entire term of my employment on this production.   I understand that the production company will be relying upon the
declaration for its application for a Louisiana production tax credit, and may be subject to government audit, and hereby
certify and warrant under the penalty of perjury under the laws of the State of Louisiana that the above information is
true and correct, and indemnify and hold the production company harmless for any misrepresentation by myself.  

           ____________________________________                        ___________________________
                                Signature of Declarant                                                             Date

                                  Circle One:
                                 
                                  I am a local hire
                                 
                                  I am a nearby hire
                                 
                                  I am a distant hire

I understand that local hires live within 60 miles of the production center.  Nearby hires fall outside of the 60 mile area
but within the jurisdiction of the Local Union administering the Agreement.   Distant hires live further out.  I indemnify the
production company and hold them harmless for any misrepresentation on my part.

                  _____________________________________                        ___________________________
                                      Signature of Declarant                                                                   Date