Form Rpd-41308 - Fuel Retailer Report
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1RPD-41308
Rev. 02/2009
*96570100*
State of New Mexico - Taxation and Revenue Department
FUEL RETAILER REPORT
Due by the 25th of the month following the report month.
Mail to: New Mexico Taxation & Revenue
Report for month of __________________
Department
Special Tax Programs and Services
Check one:
Original
Amended
P.O. Box 25123
Santa Fe, NM 87504-5123
For assistance call (505) 827-0765
Name:
FEIN/SSN/BN:
CRS ID:
Address:
City:
State:
ZIP code:
Special Fuel
Gasoline
Ethanol
Beginning physical inventory.
1.
........................................ 1.
Must agree with prior month’s ending inventory.
Receipts
2.
. ................................................................................ 2.
From Purchase Schedule.
Gallons sold during month
3.
. ............................................. 3.
Gain or (loss)
4.
. ..................................................................... 4.
Attach explanation.
Ending physical inventory
5.
. .............................................. 5.
Line 1 + Line 2 - Line 3 + or (-) Line 4
Check here if you owe a $50 penalty for late filing. Attach your payment and submit to the address above. Make your check or money
order payable to New Mexico Taxation and Revenue Department. Write your CRS ID and “Fuel Retailer Report” on the check.
I declare that I have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief it is
true, correct and complete.
(
)
Signature of authorized agent
Date
Telephone number
Title
(
)
FAX number
Printed name of authorized agent
E-mail address
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