Form Sev-5 - Report Of Severance Tax - Coal - 2007
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2RPD-41086
SEV-5
REV. 4/2007
STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
REPORT OF SEVERANCE TAX - COAL
Mail the original of this report and the total amount due to the State of New Mexico, Taxation and Revenue Department, P. O. Box 2308,
Santa Fe, NM 87504-2308 on or before the 25th day of the month following the month in which the taxable event occurs.
Phone: (505) 827-0807
TAX PERIOD
Name
Address
City, State
and Zip Code
Federal Employer Identification Number (FEIN)
(Refer to this number in all correspondence)
Tax Rate Plus
Total Severance
Location
Price per Unit
Quantity
Gross Value
Type of Coal
Surtax Rate
Tax Due
(mine, mill, pit, quarry)
Penalty for late filing (2% of total tax due per month or partial month up to 10%) ........................
IMPORTANT: See reverse
Interest for late filing (.041% of total tax due for each day the payment is late.) ..........................
side for instructions.
GRAND TOTAL OF TAXES, INTERGOVERNMENTAL TAX CREDIT, PENALTY AND
INTEREST DUE (Remit this amount) ...............................................................................................
I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct
and complete.
________________________________ ___________________________ __________________ ____________________
Signature of Taxpayer or Agent
Title
Phone No.
Mo / Day / Year
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