Form Rpd-41218 - Registration For Special Tax Programs - State Of New Mexico Taxation And Revenue Department

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RPD-41218
REV. 02/2008
STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
Special Tax Programs and Services
P.O. Box 25123
Santa Fe, NM 8750405123
REGISTRATION FOR SPECIAL TAX PROGRAMS
TRD Identification Number
Business Name
Phone Number
Mailing Address
CIGARETTE OR TOBACCO REGISTRATION - (505) 827-0762
q YES
q NO
Will business sell cigarettes?
q Retail
q Wholesale
q Distributor
q Manufacturer
q Vending Machine
Type of business:
q YES
q NO
Will business sell tobacco products?
q Retail
q Wholesale
q Distributor
q Manufacturer
q Vending Machine
Type of business:
q In-State
q Out-of-State
Place of purchase:
LIQUOR REGISTRATION - (505) 827-0768
q Retail
q Wholesale
q Distributor
q Manufacturer
Type of business:
Liquor license no. ________________________________
Type of liquor license ________________________________
WATER PRODUCER REGISTRATION - (505) 827-0763
Type of water system _______________________________
Contact person ___________________________________________
Phone number ____________________________
GASOLINE OR SPECIAL FUEL REGISTRATION - (505) 827-0773
q YES
q NO
Will business sell gasoline?
q Wholesale
q Distributor
q Rack Operator
q Importer
q Retailer
Type of business:
q YES
q NO
Will business distribute special fuel?
q Supplier
q Rack operator
q Retailer
Type of business:
SEVERANCE AND RESOURCES EXCISE TAX REGISTRATION - (505) 827-1087
q YES
q NO
Will business be engaged in severing natural resources?
Indicate type(s) of resources
__________________________________________________________________________
q YES
q NO
Will business be engaged in processing natural resources?
Indicate type(s) of resources
__________________________________________________________________________
TITLE
DATE
PRINT NAME
SIGNATURE

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