Form Rpd-41226 - Registration For Special Fuel Tax Refund printable pdf download

Form Rpd-41226 - Registration For Special Fuel Tax Refund

STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT

RPD-41226

INT. 02/2002

UPDATE

P.O. BOX 25123

SANTA FE, NM 87504-5123

1-800-305-6486

REGISTRATION FOR SPECIAL FUEL TAX REFUND

Refund applies only to vehicles registered in New Mexico. If vehicle is not registered in New Mexico or not an

apportioned New Mexico based IRP vehicle, you must include a copy of the applicable state's IRP registration.

PLEASE CHECK ALL BOXES THAT APPLY:

Special Bulk Storage User Permit

o YES

o NO

10.

STOP: Holders of Special Bulk Storage User Permits Do Not Qualify for the Refund.

11.

o Off-Highway - Description of usage in New Mexico

12.

o Auxiliary equipment by a power take-off from the main engine or transmission of the vehicle

Description of usage in New Mexico

13.

o Non-automotive apparatus permanently mounted on a vehicle using fuel from the supply

tank of the vehicle - Description of usage in New Mexico

I declare I have examined this application, including the enclosed documents, and to the best of my knowledge

and belief it is true, correct and complete.

14.

15.

____________________________________________

Name (Please Print)

Title (Please Print)

16.

17.

____________________________________________

Signature

Date

Form Rpd-41226 - Registration For Special Fuel Tax Refund