Form Rpd-41158 - Purchase Order For New Mexico Cigarette Stamps

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RPD-41158
State of New Mexico - Taxation and Revenue Department
Rev 06/2007
PURCHASE ORDER FOR NEW MEXICO CIGARETTE STAMPS
Who Must File This Form: Distributors who are required to affix New Mexico cigarette stamps according to 7-12-5 NMSA 1978 to
packages of cigarettes must use this form to order and purchase New Mexico cigarette stamps. Only distributors with a valid license
issued by the New Mexico Taxation and Revenue Department may purchase or obtain unaffixed tax-exempt stamps or tax stamps.
Filing Instructions: Complete all information requested on Form RPD-41158, Purchase Order For New Mexico Cigarette Stamps.
Indicate the method of payment. If enclosing payment, make the check or money order payable to the Taxation and Revenue
Department and mail to New Mexico Taxation and Revenue Department , Cigarette Tax Unit, P.O. Box 25123, Santa Fe, NM 87504-
5123. If ordering by fax, fax to (505) 827-1759. For assistance contact (505) 827-6842.
Name and address of purchaser
Federal employer identification or social security number
New Mexico CRS identification number
Name of person to contact
Telephone number and e-mail address
Authorized signature of purchaser
New Mexico distributor's license number
20 Stick Stamps-
One stamp pro-
Tax-exempt Stamps-
25 Stick Stamps-
Tax-exempt
One stamp pro-
vides proof that tax has been paid for a
stamps are provided free of charge to
vides proof that tax has been paid
package of 5, 10 or 20 cigarettes.
qualifying distributors.
for a package of 25 cigarettes.
20 Stick Roll
20 Stick Sheet
25 Stick Sheet
Tax-exempt Roll
Partial rolls or
(1,500 stamps per sheet)
(15,000 stamps per roll)
sheets are not
(30,000 stamps per
(1,500 stamps per
available.
roll)
sheet)
1. Quantity of
stamps requested
2. Value per stamp
$1.1375
$0.91
$0.91
$0
3. Face value-
$0
Multiply line 1 by line 2.
4. Discount
$0
(from worksheet)
5. Net value-
Sub-
$0
tract line 4 from line 3.
$
6. Cigarette Tax Due:
Sum the Net Value (line 5) of all columns, and enter here.
PAY THIS AMOUNT
Indicate method of payment:
Indicate method of shipment:
Payment is enclosed
UPS
Ground
All charge sales must be paid by
Charge sale*
Airborne
1-Day
the 25th day of the month follow-
ing the month in which the ciga-
2-Day
*Requires pre-approval (bond)
rette stamp purchase was made.
Shipper Number __________________
CIGARETTE STAMP SALE DISCOUNT WORKSHEET
Note: if the face value of stamps sold in a single sale is less than $1,000, no discount is allowed.
Face value
Rate
Discount
For the first $30,000 (face value) in cigarette stamps purchased in one calendar
$
X 1.0% =
month, 1% of the face value of the cigarette stamp purchases.
For the second $30,000 (face value) in cigarette stamps purchased in one
$
X 0.8% =
calendar month, 0.8% of the face value of the cigarette stamp purchases.
For cigarette stamps purchased in one calandar month exceeding $60,000 in
$
X 0.5% =
face value, 0.5% of the face value of the cigarette stamp purchases.

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