Form Rpd-413115 - Cigarette Distributor'S Monthly Report Form - Taxation And Revenue Department - New Mexico Page 7

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RPD-41315 Schedules
State of New Mexico
Report for
Rev 06/2007
Taxation and Revenue Department
calendar
NEW MEXICO CIGARETTE DISTRIBUTOR MONTHLY REPORT
month of: ___________________________
Schedule C - Itemized Distributed Inventory
Name of business facility
FEIN or SSN
Page ____ of ____
Distributed or Sold Cigarettes
Enter the quantity of packages of cigarettes distributed/sold in each category.
Distributed to:
Stamped Inventory
Unstamped Inventory
(Enter name and address.)
Brand Family
20's
25's
Tax exempt
Out-of-state only

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