Form Rpd-41218 - Registration For Special Tax Programs-2008
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1RPD-41218
REV. 02/2008
STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
Special Tax Programs and Services
P.O. Box 25123
Santa Fe, NM 8750405123
REGISTRATION FOR SPECIAL TAX PROGRAMS
Business Name
TRD Identification Number
Phone Number
Mailing Address
CIGARETTE OR TOBACCO REGISTRATION - (505) 827-0762
Will business sell cigarettes?
q YES
q NO
Type of business:
q Retail
q Wholesale
q Distributor
q Manufacturer
q Vending Machine
Will business sell tobacco products?
q YES
q NO
Type of business:
q Retail
q Wholesale
q Distributor
q Manufacturer
q Vending Machine
Place of purchase:
q In-State
q Out-of-State
LIQUOR REGISTRATION - (505) 827-0768
Type of business:
q Retail
q Wholesale
q Distributor
q Manufacturer
Liquor license no. ________________________________
Type of liquor license ________________________________
WATER PRODUCER REGISTRATION - (505) 827-0763
Type of water system _______________________________
Contact person ___________________________________________
Phone number ____________________________
GASOLINE OR SPECIAL FUEL REGISTRATION - (505) 827-0773
Will business sell gasoline?
q YES
q NO
Type of business:
q Wholesale
q Distributor
q Rack Operator
q Importer
q Retailer
Will business distribute special fuel?
q YES
q NO
Type of business:
q Supplier
q Rack operator
q Retailer
SEVERANCE AND RESOURCES EXCISE TAX REGISTRATION - (505) 827-1087
Will business be engaged in severing natural resources?
q YES
q NO
Indicate type(s) of resources
__________________________________________________________________________
Will business be engaged in processing natural resources?
q YES
q NO
Indicate type(s) of resources
__________________________________________________________________________
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DATE
PRINT NAME
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Parent category: Financial