Acd 31052 Form PDF Details

Diane, a 32-year old woman, was in an automobile accident. She suffered a broken arm and was taken to the ER. The ER physician assessed her and determined that she needed immediate surgery to repair her arm. Before the surgery could be scheduled, however, Diane had to complete an Acd 31052 form. This form authorizes the release of medical information to insurance companies and other interested parties. Without it, the hospital would not be able to proceed with the surgery. Diane completed the Acd 31052 form and faxed it to the insurance company as instructed by the ER physician. Unfortunately, Diane's arm healed improperly as a result of the delay caused by completing this form. Now she is suing the insurance company

QuestionAnswer
Form NameAcd 31052 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesseries 1992 nontaxable transaction certificate, nttc certificate, new mexico nttc, non taxable transaction certificate

Form Preview Example

ACD-31052

REV. 02/2005

SERIES 1992 - NONTAXABLE TRANSACTION CERTIFICATE - SERIES 1992

SELLER'S/LESSOR'S COPY

New Mexico Taxation and Revenue Department

PO Box 5557, Santa Fe, New Mexico 87502-5557

Certificate Type:

TYPE2

Certificate Number: B-3002073-02-00006

Date Issued:

4/17/2009

 

 

 

EXECUTED BY:

 

 

 

 

 

EXECUTED TO:

(ENTER SAME INFORMATION INTO BUYER'S COPY BELOW)

Buyer's New Mexico CRSID#:

03-002073-00-5

 

 

 

Seller's New Mexico CRSID#:

208493827

 

 

Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name:

 

 

 

 

 

 

RESOURCEOFFICEPRODUCTS, INC.

 

 

 

TEGRANT CORPORATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

3930 VENTURADRIVE, SUITE450

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8527 CALLE ALAMEDANE

 

 

 

 

City:

State:

 

Country:

Zip:

ALBUQUERQUE

NM

USA

87113-1543

 

 

ARLINGTON HEIGHTS IL

 

USA

60004-0000

 

 

 

 

 

 

 

 

 

 

 

 

 

Contract Number:

Contract Expiration Date:

 

 

 

 

 

 

 

 

 

Date Certificate Executed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(cannot be prior to date issued)

 

 

4/17/2009

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aseller may not accept this nontaxable transaction certificate to support a deduction from gross receipts unless the seller has a good-faith belief that the buyer will resell,

lease or use the property or service soldor leasedin the manner representedby the nontaxable transaction certificate.

TYPE2 CERTIFICATES MAYBEEXECUTED:

1)By manufacturers for the purchase of tangible personal property that will become an ingredient or component of the product manufactured product. Section 7-9-46 NMSA 1978), formerly Type 1;

2)For the purchase of tangible personal property or licenses for resale either alone or in combination with other tangible personal property or licenses in the ordinary course of business. (Section 7-9-47 NMSA 1978);

3)By the lessee for the lease of tangible personal property or licenses for subsequent lease in the ordinary course of business except for, the lease of furniture or appliances (the receipts from the rental or lease of which are deductible under Subsection C of Section 7-9-53 NMSA 1978), the lease of coin-operated machines, and for the purchase of manufactured homes as defined in Section 7-9-53(G) NMSA 1978, (Section 7-9-49 NMSA 1978), formerly Type 3;

4)For the purchase of tangible personal property or licenses for subsequent lease in the ordinary course of business except for, the lease of furniture or appliances (the receipts from the rental or lease of which are deductible under Subsection C of Section 7-9-53 NMSA 1978), the lease of coin-operated machines, and for the purchase of manufactured homes as defined in Section 7-9-3(G) NMSA 1978. (Section 7-9-49 NMSA 1978), formerly Type 4.

C A U T I O N:

·A personwhomisuses this certificate maybe subjecttosuspensionofthe righttouse nontaxable transactioncertificates (Section7-9-44NMSA 1978).

·A person who executes a nontaxable transaction certificate to acquire property or a service, but then converts that property or service to use in a mannerotherthanthatprovided bythe NTTC, is liable forcompensatingtax (Section7-9-7NMSA 1978).

SERIES 1992 - NONTAXABLE TRANSACTION CERTIFICATE - SERIES 1992

- - - - - - CUT HERE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

CUT HERE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

CUT HERE - - - - - -

BUYER’S COPY

The information below MUST be entered into the New Mexico Taxation and Revenue Department’s NTTC.NET web-site at: www.state.nm.us/tax or you cansend acopy ofthis form totheDepartment at theaddress below.

Certificate Type:

TYPE 2

Certificate Number: B-3002073-02-00006

Date Issued: 4/17/2009

 

 

 

EXECUTED BY:

 

 

 

 

 

 

EXECUTED TO:

 

 

 

 

 

 

Buyer's New Mexico CRSID#:

03-002073-00-5

 

 

 

Seller's New Mexico CRSID#:

 

208493827

 

 

 

Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name:

 

 

 

 

 

 

RESOURCE OFFICE PRODUCTS, INC.

 

 

 

 

TEGRANT CORPORATION

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

3930 VENTURA DRIVE, SUITE 450

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

8527 CALLE ALAMEDA NE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

State:

Country:

Zip:

 

 

 

 

 

 

 

 

ALBUQUERQUE

NM

USA

87113-1543

 

 

 

ARLINGTON HEIGHTS

IL

USA

60004-0000

 

 

Contract Number:

Contract Expiration Date:

 

 

 

 

 

 

 

 

Date Certificate Executed:

 

4/17/2009

 

 

 

 

 

 

 

 

 

(cannot be prior to date issued)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Mexico Taxation and Revenue Department

 

 

 

 

 

 

 

 

PO Box 5557, Santa Fe, New Mexico 87502-5557

 

 

 

 

BUYER’S COPY:

 

NONTAXABLE TRANSACTION CERTIFICATE–SERIES 1992