Form Rpd-41306c - Schedule Of Disbursements
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1State of New Mexico - Taxation & Revenue Department
RPD-41306C
REV. 07/2009
COMBINED FUEL TAX REPORT FOR DISTRIBUTORS, SUPPLIERS AND WHOLESALERS
SCHEDULE OF DISBURSEMENTS
Distributor/supplier/wholesaler name
FEIN / CRS
Schedule type
Month/Year
PRODUCT TYPE - (CHECK ONE BOX)
SCHEDULE TYPE:
5A
Gallons sold to retailers/consumers in New Mexico - New Mexico taxable sales
065 Gasoline
5B
Gallons sold to distributors/suppliers/wholesalers - tax included
123 Ethanol
7
Gallons exported out of New Mexico
160 Diesel fuel
8
Gallons sold to U.S. Govt., NATO or Indian tribes for their exclusive use (direct or indirect)
228 Diesel fuel - dye added
9
Gallons sold to NM state and local governments for their exclusive use (direct or indirect)
170 Biodiesel
10T Gallons sold at retail on Indian land by a registered Indian tribal distributor
171 Dyed biodiesel
6V
Gallons sold at retail on Indian land by other than a registered Indian tribal distributor
Other products ____________
10F Gallons of undyed special fuel sold for off-road use
10G Gallons of undyed and dyed special fuel sold for school bus use
10A Gallons of dyed gasoline, ethanol and special fuel sold (Do not include gallons sold for school bus use.)
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Carrier
Carrier
Purchaser
Purchaser
Date
B O L or
Net
Gross
Mode
name
FEIN
name
FEIN
shipped
invoice number
gallons
gallons
POINT OF
ORIGIN
DESTINATION
Total gallons
RPD41306C
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