Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates (Page 3 of 14) in pdf

Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates Page 3

RPD-41378

Section G: Natural Gas Consumed in the Manufacturing Process

Rev. 04/30/2013

You must complete Section G to obtain approval to execute a Type 12 Nontaxable Transaction Certificate (NTTC)

for natural gas that is consumed in the manufacturing process. Complete a new Section G for each manufacturing

facility location where you manufacture products to which all or part of the natural gas used is consumed in the

manufacturing process. You must complete this section to benefit from the deduction for natural gas consumed

in the manufacturing process. A signed agreement between you and the utility company supplying the natural gas

must accompany this application. You must maintain all records necessary to demonstrate the validity and accu-

racy of the natural gas consumed in the manufacturing process.

Check one to describe the application submitted.

New application

Renewal of an application

Report changes on a previous application

(Every three years)

NM CRS identification number

Name

Enter the physical location of the facility where the manufacturing process occurs.

Physical address

ZIP

City

State

E-mail address

Name of contact

Phone number

Your utility company

Meter number

Name of the company supplying the natural gas

account number

CRS number for the utility company

1. Enter the estimated percentage of the total gas consumed at the facility where the

manufacturing process occurs that is consumed in the manufacturing process.

2. In the space below, describe the basis for the estimated percentage used in line 1.

For Department Use Only

This application for a Type 12 NTTC is approved by the Taxation and Revenue Department and authorizes that

the Type 12 NTTC may be executed by the applicant named, to the utility company selling the natural gas for

purposes of the deduction for the natural gas consumed in the manufacturing process that is conducted at the

above location.

The percentage of the total natural gas that is consumed in the manufacturing process is:

This Type 12 NTTC may be allowed for natural gas sold on or after:

But not after:

Signature of Secretary or Delegate

Date

Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates Page 3