Form RPD-41212 Investment Credit Claim Form

CRS 1 Form PTE Form * Enter same report period as entered on your attached tax form *This is the maximum amount of Investment Credit that can be applied to this reporting period A Enter the total of all taxable gross receipts reported (Column F of the CRS 1) A Attach this form to the tax return to which you wish to apply the credit and mail to the address on the tax return For assistance call: 505 827 2632 Attach to applicable New Mexico tax form B Multiply Line A amount by 5 125 percent and enter the amount here B Business Name Approval Number C Enter the Compensating Tax reported (Line 2 of the CRS 1) C Check One D Enter the Withholding Tax reported (Line 3 of the CRS 1 or Line 5 of the PTE return) D E Enter the sum of Lines B C and D E F Multiply Line E by 85%* F INSTRUCTIONS FOR USING THIS FORM: When claiming an approved investment credit this claim form must accompany the CRS 1 or PTE return to which the taxpayer wishes to apply the credit Complete the Investment Credit Claim Form and mail to the address below along with the return and any applicable payments INVESTMENT CREDIT CLAIM FORM Month Day Year Month Day Year REPORT PERIOD* Requesting application of approved Investment Credits to the attached form Rev 11/14/2011 RPD 41212 Signature of Taxpayer or Agent Date Phone Number State of New Mexico Taxation and Revenue Department TAXPAYER IDENTIFICATION NUMBER AMOUNT OF INVESTMENT CREDIT TO BE APPLIED through Use the worksheet below to calculate the maximum amount of approved Investment Credit that may be applied to this reporting period Any amount of credit not claimed for a reporting period may be claimed in subsequent reporting periods WORKSHEET