Pueblo Of Laguna Gross Receipts Tax Form Page 2
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1
2Tax Administration Division
P.O. Box 194 LAGUNA, NEW MEXICO 87026
(505) 552‐6654
(C) Tax Due from Sales of Goods or Services in Cibola County
$______________________ Amount of Sales or Services in Cibola County
0.00
$______________________ Amount of Exempt Sales of Goods or Services*
6.5625%
= $______________________ Amount of Taxable Sales of Goods or Services
x ______________________ (Cibola County Tax Rate)
+
0.00
= $______________________ Gross Receipts Tax Due to the Pueblo of Laguna
(D) Tax Due from Sales of Goods or Services in Valencia County
$______________________ Amount of Sales or Services in Valencia County
0.00
$______________________ Amount of Exempt Sales of Goods or Services*
6.8750%
= $______________________ Amount of Taxable Sales of Goods or Services
x ______________________ (Valencia County Tax Rate)
+
0.00
= $______________________ Gross Receipts Tax Due to the Pueblo of Laguna
*See P.O.L.C § 6‐3‐6 for list of Exemptions
+Rates subject to change
Box 5
*(E) Credits / Allowances:
………………………………………………………… $____________________________
Enter as a negative (-) number
*Enter any credits or allowances allowed by the Pueblo of Laguna Tax Administration Division. Attach copy of “Credits and
Allowances” worksheet issued by the Division.
Box 6
Total Taxes Due to the Pueblo (A+B+C+D‐E) = $_____________________________________
0.00
Box 7
I declare, under penalty of perjury, that all information provided within this return is true, correct and
complete to the best of my knowledge. I acknowledge that failure to report all taxable sales and pay all
taxes due in accordance with Section 6‐3‐9 P.O.L.C. will result in the assessment of interest and penalties
pursuant to Section(s) 6‐1‐24 and 6‐1‐25 P.O.L.C. I further acknowledge that any attempts to willfully
evade or defeat any tax of the Pueblo of Laguna will result in the assessment of civil penalties in
accordance with Section 6‐1‐26 P.O.L.C.
_______________________________________________________ ___________________________________________________
Name (please print)
Title
_______________________________________________________ ______ /______ /______
Signature
Date
Pueblo of Laguna Gross Receipts Tax Form
Rev. 10/2014
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