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
Question | Answer |
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Form Name | Acd 31052 Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | series 1992 nontaxable transaction certificate, nttc certificate, new mexico nttc, non taxable transaction certificate |
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
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TYPE2 |
Certificate Number: |
Date Issued: |
4/17/2009 |
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EXECUTED BY: |
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EXECUTED TO: |
(ENTER SAME INFORMATION INTO BUYER'S COPY BELOW) |
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Buyer's New Mexico CRSID#: |
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Seller's New Mexico CRSID#: |
208493827 |
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Company Name: |
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Company Name: |
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RESOURCEOFFICEPRODUCTS, INC. |
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TEGRANT CORPORATION |
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Address |
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3930 VENTURADRIVE, SUITE450 |
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8527 CALLE ALAMEDANE |
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ALBUQUERQUE |
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ARLINGTON HEIGHTS IL |
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Contract Number: |
Contract Expiration Date: |
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Date Certificate Executed: |
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(cannot be prior to date issued) |
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4/17/2009 |
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Aseller may not accept this nontaxable transaction certificate to support a deduction from gross receipts unless the seller has a
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
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
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
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
C A U T I O N:
·A personwhomisuses this certificate maybe subjecttosuspensionofthe righttouse nontaxable transactioncertificates
·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
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
Certificate Type: |
TYPE 2 |
Certificate Number: |
Date Issued: 4/17/2009 |
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EXECUTED BY: |
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EXECUTED TO: |
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Buyer's New Mexico CRSID#: |
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Seller's New Mexico CRSID#: |
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208493827 |
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Company Name: |
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Company Name: |
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RESOURCE OFFICE PRODUCTS, INC. |
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TEGRANT CORPORATION |
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Address |
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3930 VENTURA DRIVE, SUITE 450 |
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8527 CALLE ALAMEDA NE |
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ALBUQUERQUE |
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ARLINGTON HEIGHTS |
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Contract Number: |
Contract Expiration Date: |
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Date Certificate Executed: |
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4/17/2009 |
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New Mexico Taxation and Revenue Department |
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PO Box 5557, Santa Fe, New Mexico |
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BUYER’S COPY: |
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NONTAXABLE TRANSACTION |
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