Fuel Retailer Report Form - 2005
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1State of New Mexico - Taxation & Revenue Department
RPD-41308
FUEL RETAILER REPORT
INT. 12/2005
Original
Amended
REPORT FOR MONTH OF ____________, _______
FEIN, SSN or BN ________________
Please send report to:
CRS ID
_______________________
New Mexico Taxation & Revenue Dept.
Name
________________________
Special Tax Programs & Services
Address ________________________
P O Box 25123
________________________
Santa Fe, NM 87504-5123
________________________
Phone 505-827-0765
GASOLINE
ETHANOL
SPECIAL FUEL
1
Beginning Physical Inventory:
Must agree with prior month's ending inventory
2
Receipts:
From Purchase Schedule
3
Gallons Sold During Month:
(
)
(
)
(
)
4
Gain or (Loss):
Attach explanation
5
Ending Physical Inventory:
+
-
+
-
Line 1
Line 2
Line 3
or (
) Line 4
*
Return is due by the 25th of the month following the report month.
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
Title
______________________________________
________________________________________
Printed Name of Authorized Agent
Date
____________________________
_____________________________
__________________________
Telephone #
FAX #
Email Address
RPD41308
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