Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates (Page 5 of 14) in pdf

Form Rpd-41378 - Application For Type 11 Or 12 Nontaxable Transaction Certificates Page 5

RPD-41378

Section O: Other Utilities Consumed in the Manufacturing Process

Rev. 04/30/2013

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

for utilities other than electricity, natural gas or water that is consumed in your manufacturing process. Complete

a new Section O for each manufacturing facility location where you manufacture products to which all or part

of the utility used is consumed in the manufacturing process. You must complete this section to benefit from the

deduction for the utility consumed in the manufacturing process. A signed agreement between you and the utility

company supplying the utility must accompany this application. You must maintain all records necessary to dem-

onstrate the validity and accuracy of the utility 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

Meter number

Name of the company supplying the other utility

account number

CRS number of the utility company

Describe the utility consumed in the manufacturing operation

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

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

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

This Type 12 NTTC may be allowed for the utility 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 5