Distributors Gasoline And Ethanol Blended Fuel Tax Report Form - State Of New Mexico

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State of New Mexico - Taxation & Revenue Department
DISTRIBUTORS GASOLINE AND ETHANOL BLENDED FUEL TAX REPORT
MONTHLY REPORT FOR MONTH OF
,
DUE NO LATER THAN THE 25TH OF THE FOLLOWING
MONTH.
Original
Please return report and remittance to:
New Mexico Taxation & Revenue Dept.
Amended
Special Tax Programs & Services
P>O> Box 25123
Santa Fe, NM 87504
(505) 827-0764
INVENTORY RECONCILIATION
GASOLINE
ETHANOL
1. Beginning Inventory.............................................................
1.
2. Purchases (Line 16).............................................................
2.
3. Sales (Lines 9 & 22)............................................................
3.
4. Inventory Adjustment: Gain/(Loss)....................................
4.
5. Ending Inventory.................................................................
5.
SALES
6. Tax-included sales to retailers/consumers (GTX-15).......
6.
7. Tax included sales to wholesalers/distributors (Sch E)
7.
8. Tax excluded sales (Sch P)..
8.
9. TOTAL SALES (Sum of lines 6, 7, 8)
......................
9.
PURCHASES
10. Gallons received at rack, produced or blended (Sch A)
10.
11. Gallons received when imported (Schedule B)...................
11.
12. Gallons received-transported off Indian land (Sch C)
12.
13. Total gallons received - Sum of lines 10 through 12......
13.
14. Other acquired gallons purchased (Schedule D)................
14.
15. Gallons purchased from a certified distributor (Sch D)..
15.
16. TOTAL PURCHASES (Sum of lines 13, 14, 15,
16.
must equal line 2)...................
DEDUCTIONS
17.
17. Gallons sold to US> Gov or Indian Tribes (Sch F & G)
18.
18. Gallons which were exported out of state (Sch H & I)
19.
19. Gallons dyed and sold for off-road use (Sch J & K)
20.
20. Gallons sold at retail on Indian Land (Sch L & M)
21.
21. Gallons sold by a certified distributor (Sch N & O)
22.
22. TOTAL DEDUCTIONS (Lines 17 through 21)...................
COMPUTATION OF TAX
23. Net taxable gallons - Line 13 less line 22........................
23.
24. Tax due @ .17 cents per gallon.........................................
24.
25. Penalty (2% of line 24 per month or partial month).......
25.
26. Interest (Line 24 x .000411 x number of days late).
26.
27. TOTAL TAX, PENALTY AND INTEREST.......................
27.
I declare that I have examined this return, including any accompanying schedules and statements, and to the best
of my knowledge and belief it is true, correct and complete
Signature of Authorized Agent
Date
Phone Number
GTX15 rev 06/01

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