Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates (Page 4 of 14) in pdf

Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates Page 4

RPD-41378

Section W: Water Consumed in the Manufacturing Process

Rev. 04/30/2013

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

for water that is consumed your manufacturing process. Complete a new Section W for each manufacturing facil-

ity location where you manufacture products to which all or part of the water used is consumed in the manufac-

turing process. You must complete this section to benefit from the deduction for water consumed in the manu-

facturing process. A signed agreement between you and the utility company supplying the water must accompany

this application. You must maintain all records necessary to demonstrate the validity and accuracy of the water

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

Name of contact

Phone number

E-mail address

Your utility company

Name of the company supplying the water

Meter number

account number

CRS number for the water company

1. Enter the estimated percentage of the total water 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 water for purposes

of the deduction for the water consumed in the manufacturing process that is conducted at the above location.

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

This Type 12 NTTC may be allowed for water 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 4