CRS-1-Long Form CRS-1 Combined Report-Long Form For More Than 3 Business Locations, Codes or Lines of Detail

P O Box 25128 Santa Fe NM 87504 5128 2 COMPENSATING TAX 3 WITHHOLDING TAX 4 TOTAL TAX DUE 5 PENALTY 6 INTEREST 7 TOTAL AMOUNT DUE Check if applicable: Amended reportT A X P E R I O D CITY STATE ZIP COMBINED REPORT SYSTEM CRS 1 LONG FORM PAGE 1 CRS 1 LONG FORM Supplemental COMBINED REPORT SYSTEM Do not submit a photocopy of these forms to the Department If additional space is needed please obtain an original form from your local district office or download the form from our web site at www tax newmexico gov Enter total of columns D E and H this page * See instructions for column B $ $ $ If additional space is needed use the supplemental page If supplemental pages are attached enter total of all columns D E and H from this page and all supplemental pages $ $ $ Municipality / county nameA BSpecialcode* C Location code D Gross receipts(excluding tax) E Total deductions F Taxable gross receipts G Tax rate H Gross receipts tax NAME NEW MEXICO CRS ID NO Page of Payment made by: Automated clearinghouse deposit Federal wire transfer Date Date Rev 09/2010 Rev 09/2010 Mail to: NM Taxation and Revenue Department Signature of taxpayer or agent I declare that I have examined this return including any accompany ing schedules and statements and to the best of my knowledge and belief it is true correct and complete Print name Date Title Phone E mail address 1 TOTAL GROSS RECEIPTS TAX ALL PAGES State of New Mexico Taxation and Revenue Department STREET / BOX T A X P E R I O D Total columns D E and H this page * See instructions for column B $ $ $ Use this page if additional space is needed to report gross receipts from multiple locations Attach this page to Page 1 of the CRS 1 Long Form