Business Name
CIGARETTE OR TOBACCO REGISTRATION (505) 827 0762
Contact person Phone number
GASOLINE OR SPECIAL FUEL REGISTRATION (505) 827 0773
Indicate type(s) of resources
Liquor license no Type of liquor license
LIQUOR REGISTRATION (505) 827 0768
Mailing Address
P O Box 25123
Phone Number
Place of purchase: q In State q Out of State
PRINT NAME
REGISTRATION FOR SPECIAL TAX PROGRAMS
REV 02/2008
RPD 41218
Santa Fe NM 8750405123
SEVERANCE AND RESOURCES EXCISE TAX REGISTRATION (505) 827 1087
SIGNATURE
Special Tax Programs and Services
STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
TITLE
TRD Identification Number
Type of business: q Retail q Wholesale q Distributor q Manufacturer
Type of business: q Retail q Wholesale q Distributor q Manufacturer q Vending Machine
Type of business: q Supplier q Rack operator q Retailer
Type of business: q Wholesale q Distributor q Rack Operator q Importer q Retailer
Type of water system
WATER PRODUCER REGISTRATION (505) 827 0763
Will business be engaged in processing natural resources? q YES q NO
Will business be engaged in severing natural resources? q YES q NO
Will business distribute special fuel? q YES q NO
Will business sell cigarettes? q YES q NO
Will business sell gasoline? q YES q NO
Will business sell tobacco products? q YES q NO
