Form Rpd - 41136 - Application For Tax Refund - Oil And Gas

Form Rpd - 41136 - Application For Tax Refund - Oil And Gas - 2008

NEW MEXICO TAXATION AND REVENUE DEPARTMENT

RPD - 41136

REV. 12//08

P.O. Box 2308

Santa Fe, NM 87504-2308

(505) 827-1087

APPLICATION FOR TAX REFUND - OIL AND GAS

(FORM RPD-41136)

This form is to be used when applying for a tax refund from the Taxation and Revenue Department.

Attach a letter of explanation if the space provided for basis for refund is insufficient.

Attach copies of documents that support your claim.

The Taxation and Revenue Department has the right to offset all or part of this overpayment against any outstanding assessments

you may owe.

The Taxation and Revenue Department, in the appropriate circumstances has the right to grant all or part of this overpayment as a

credit against any future tax liabilities you may owe.

This form must be signed by the taxpayer or the taxpayer's authorized agent.

Attach completed copies of RPD-41131 Oil & Gas Taxes Summary Report and RPD-41132 Oil & Gas Taxes Detail Report amending

appropriate taxes previously paid.

Company Name

New Mexico OGRID Identification Number

Mailing Address

City, state, zip code

I certify that the State of New Mexico was overpaid the sum of ________________________________________________ dollars

($___________________________)

for the sales month(s) of _________________________________________________ for the following type of taxes (check one):

Oil and Gas Production Taxes (Severance, Conservation, School and Ad Valorem)

Oil and Gas Production Equipment Ad Valorem Tax

Natural Gas Processors Tax

Advance Payment for Year(s)___________________________________

Basis for refund:

I declare that the information reported on this form and any attached supplements is true and correct as to every material matter.

Type or print name

Title

Phone Number

(

)

Signature of taxpayer or agent

Date

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Form Rpd - 41136 - Application For Tax Refund - Oil And Gas - 2008