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Form Rpd 41188 - Non-Participating Manufacturer Brand Cigarettes Distributed Or Sold

RPD 41188

State of New Mexico - Taxation and Revenue Department

Rev. 06/2007

NON-PARTICIPATING MANUFACTURER BRAND CIGARETTES DISTRIBUTED OR SOLD

Reporting Month/Year: ________________________

page ___1__ of ______

Distributors, manufacturers and retailers who distribute or sell cigarettes or “roll-your-own” tobacco products made by Non-participating Manufacturers (NPM), must

report the cigarette distributions or sales if the products were stamped by their organization for sale within New Mexico or if the tobacco excise tax was paid by the

distributor, manufacturer or retailer, to the state of New Mexico for sale within New Mexico. Attach to Form RPD-41315, Cigarette Distributor’s Monthly Report, and mail

to the Department by the 25th day of the month following the close of the report month. Mail to: New Mexico Taxation and Revenue Department, Cigarette Tax Unit, P.O. Box 25123,

Santa Fe, NM 87504-5123. For assistance call (505) 827-6842.

Business Name: _________________________________________________NM CRS Id. No.:_________________FEIN or SSN:_______________

NM Cigarette Distributor’s or Manufacturer’s License No.:_______________ Contact person: _________________________ Phone: ____________

If you have NOT distributed or sold any cigarettes or “roll-your-own” tobacco products made by Non-participating Manufacturers in New

Mexico, check the “No NPM report due” box at the top of Schedule C, Itemized Distributed Inventory, and do not submit this form.

No. of NPM

Ounces of NPM roll-

Name and address of the person(s)

Name and address of the first

Brand Family

Name and address of NPM who

cigarette sticks