STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
FUELS TAX UNIT
SPECIAL FUEL SUPPLIERS SCHEDULE OF PURCHASES
SCHEDULE TYPE:
Taxpayer ID#
MONTH/YR
A.
Gallons received from rack operator, produced or blended
Company Name
Gallons Imported from State of
B.
Other Gallons Purchased
C..
NM Tax
Business
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Document
Tax Excluded
Tax Included
Identification Number
Name
Point
Date
Number
Gallons
Gallons
TOTALS
TXSFS1 rev 06/00