Attachment_30-_NMGRT_Invoice_Certification_-_no_date.pdf

Acknowledgment & Certification of New Mexico Gross Receipt Tax Invoice

For Official Use Only Page 1 of 1

I, (Name of individual) , representing (name of Company or Jt venture) acknowledge and certify that the invoiced amount associated with invoice number ________ and taks order number ___________, accounts for New Mexico Gross Receipt Tax in the amount of $ .

I further acknowledge the coefficients established under contract FA4855-18-D-____ was proposed as fully burdened and inclusive of New Mexico Gross Reciept Tax.

Printed Name, Position, Company Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address:

27 SOCONS LGCB

110 E. Alison Ave Cannon AFB, NM 88103-5321 FAX to: 575-784-1147 E-Mail to: sarah.muraco@us.af.mil

Signature

Attachment 30 FA4855-18-R-0003