Form Rpd-41209 - Gaming Operator Tax Return - 2010

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State of New Mexico
RPD-41209
Rev. 07/2010
Taxation and Revenue Department
GAMING OPERATOR TAX RETURN
WHEN TO FILE: The gaming operator tax is due on or before the 15th day of the month following the month in which the
taxable event occured.
Detach the bottom portion and submit with check made payable to: New Mexico Taxation and Revenue Department. Mail
to: P.O. Box 25123, Santa Fe, NM 87504-5123. See the instructions for this form. If you have any questions about filing this
form, please call (505) 827-0792.
Report Month:
1.
(mm/ccyy)
1. Net Take
2. Tax Due
2.
Fraternal Organization - (Nonprofit Gaming Licensee)
Racetrack Gaming Operator Licensee
3. Penalty
3.
Original Return
4. Interest
4.
Amended Return
5. Total Due
5.
NAME:
6. Total Paid
6.
STREET/BOX:
SSN or FEIN:
CITY, STATE, ZIP:
CRS:
PLEASE CUT AND INCLUDE THE BOTTOM PORTION WITH YOUR PAYMENT
RETAIN THE UPPER PORTION FOR YOUR RECORDS
Gaming Operator Tax
1.
1. Net Take
Report Month:
(mm/ccyy)
2. Tax Due
2.
Fraternal Organization - (Nonprofit Gaming Licensee)
Racetrack Gaming Operator Licensee
3. Penalty
3.
Original Return
4. Interest
4.
Amended Return
NAME:
5. Total Due
5.
6. Total Paid
6.
STREET/BOX:
SSN or FEIN:
CITY, STATE, ZIP:
CRS:
GMO
Signature ___________________________ Date ______________ Phone ______________ E-mail address: _______________________________

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