Form Rpd 41189 - Licensed Distributor Reporting Form And Instructions For Cigarette Sales Of Non-Participating Manufacturer Brands
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1RPD 41189
State of New Mexico - Taxation and Revenue Department
Rev. 06/2004
Licensed Distributor Reporting Form and Instructions for Cigarette Sales of Non-Participating Manufacturer Brands
Supplemental Form
Reporting Month/Year: _______________________
page _____ of ______
Business Name: ____________________________________________
FEIN: __________________________
No. of
Ounces of roll-your-
Name and address of the person(s)
Name and address of the first
Brand Name
Non-participating
(column a)
cigarettes sold
own tobacco sold
manufacturer name and
from whom each brand
importer of foreign manufactured
within state
within state
address
was purchased
brands (if known)
(column b)
(column c)
(column e)
(column f)
(column d)
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