Form Rpd-41109 - Water Conservation Fee Return

Form Rpd-41109 - Water Conservation Fee Return - 2010

STATE OF NEW MEXICO

RPD-41109

Rev. 06/2010

TAXATION AND REVENUE DEPARTMENT

WATER CONSERVATION FEE RETURN

WHO MUST FILE: On every person who operates a public water supply system is imposed a water conservation fee

in an amount equal to three cents ($0.03) per thousand gallons of water produced. See the instructions for important

definitions.

WHEN TO FILE: The water conservation fee is due on or before the 25th day of the month following the close of the

reporting period in which the water was produced. If no water was produced for the applicable reporting period, no

report is due. A reporting period may be monthly, quarterly or semi-annually.

Make the check or money order payable to Taxation and Revenue Department. Mail the bottom portion of this form

with payment to:

New Mexico Taxation and Revenue Department

P.O. Box 25123

Santa Fe, NM 87504-5123

Retain the top portion for your records. For assistance call (505) 827-0763.

REPORT PERIOD:

FEIN:

Beginning (mm-dd-yy)

Ending (mm-dd-yy)

SSN:

1. Total gallons subject to fee

CRS:

NAME:

2. Line 1 divided by 1,000

3. Total fee (Line 2 x 0.03)

STREET/BOX:

4. Penalty

CITY, STATE, ZIP:

5. Interest

6. Total due

PLEASE CUT AND INCLUDE THE BOTTOM PORTION WITH YOUR PAYMENT

RETAIN THE UPPER PORTION FOR YOUR RECORDS

WATER CONSERVATION FEE