Form Rpd-41179 - Wholesaler'S Gasoline And Ethanol Blended Fuel Tax Report Page 2

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STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
Wholesaler's I.D. Number ______________________________
Wholesaler's Name ___________________________________
Wholesaler's Address _________________________________
For the Calendar Month: _____________________
MUNICIPALITY
LOCATION
MUNICIPALITY
LOCATION
MUNICIPALITY
LOCATION
GALLONS
GALLONS
GALLONS
OR COUNTY
CODE
OR COUNTY
CODE
OR COUNTY
CODE
BERNALILLO
HIDALGO
SAN JUAN
LEA
SAN MIGUEL
CATRON
CHAVES
SANTA FE
LINCOLN
SIERRA
CIBOLA
LOS ALAMOS
COLFAX
LUNA
SOCORRO
McKINLEY
TAOS
MORA
CURRY
OTERO
TORRANCE
DE BACA
QUAY
DONA ANA
UNION
RIO ARRIBA
EDDY
VALENCIA
ROOSEVELT
GRANT
TOTAL GALLONS
SANDOVAL
GUADALUPE
Include taxable gasoline and ethanol deliveries on
this form. Total gallons must equal line 9 on the front
HARDING
of this forms.

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