Form Rpd-41307 - Rack Operator Report - State Of New Mexico - Taxation And Revenue Department

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RPD-41307
Rev. 03/2011
*96560100*
State of New Mexico - Taxation and Revenue Department
RACK OPERATOR REPORT
Report for month of __________________
Due by the 25th of the month following the close of the report month.
mm/dd/ccyy
Check one:
Original
Amended
Mail to: New Mexico Taxation & Revenue
Department
TERMINAL
Special Tax Programs and Services
Name of terminal:
Terminal code:
P.O. Box 25123
Santa Fe, NM 87504-5123
Location of terminal:
For assistance call (505) 827-0765
OPERATOR
Name:
CRS ID:
Phone number:
FEIN/SSN/BN:
(
)
Address:
ZIP code:
City:
State:
TRANSACTIONS FOR THE MONTH
Circle one: Net Gallons or Gross Gallons
Schedule
Gasoline Products
Special Fuel Products
Other Products
Number
1.
Gallons sold to registered distributors or
6
suppliers...........................................................
2.
Gallons sold/purchased through exchange
6X
agreements.......................................................
3.
Gallons exported directly outside of New
7
Mexico...............................................................
4.
Gallons sold and shipped directly to a regis-
tered Indian tribal distributor on Indian land.
10
5.
Gallons sold and shipped directly to other
than registered Indian tribal distributors on
Indian land........................................................
10A
Check here if you owe a $50 penalty for late filing. Attach your payment and submit to the address above. Make your check or money
order payable to New Mexico Taxation and Revenue Department. Write your CRS ID and “Rack Operator Report” on the check.
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
Date
Telephone number
(
)
Printed name of authorized agent
E-mail address
FAX number

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