Form RPD-41246 Income Tax Credit for Electronic Card Reader

CRS Identification No Liquor Licence No Name of Business Eligible for the Credit Name of Contact Address of Contact Phone Number 1 Physical address of business location using electronic identification card reader(s) 1) the business is licensed to sell cigarettes tobacco products or alcoholic beverages and 2 Physical address of business location using electronic identification card reader(s) 2) the business has purchased and has in use equipment that electronically reads identification cards to verify age 3 Physical address of business location using electronic identification card reader(s) 4 Physical address of business location using electronic identification card reader(s) A husband and wife filing separate returns may each claim only one half the allowable credit amount A partnership or other ABOUT THIS CREDIT amounts cannot be carried forward or back into another taxable year Beginning with tax year 2001 a one time income tax credit is available for businesses that purchase electronic identification business association of which the taxpayer is a member may claim a credit only in proportion to the taxpayer's interest in the card readers A business may claim this credit on its New Mexico personal income tax return or corporate income and franchise Claimant Information Claimant Statement Complete this Purchase and Use Statement and have it notarized Indicate the amount of credit claimed on the appropriate line of your personal income tax return corporate income and franchise tax return or pass through entity tax return Submit this statement with your return When the credit ($300 for each business location) is split between spouses partners or other business associates each claimant must submit the claimant's income tax return with a Purchase and Use Statement for the portion of the credit claimed including information on the division of the total credit below Division of the total credit If the credit for the eligible business is divided among two or more individuals complete the following information for each eligible owner partner or associate below Enter the name(s) of all business owner(s) partner(s) or associate(s) eligible to claim the credit on this application Attach a supplemental report if additional space is needed The total credit cannot exceed $300 per business location See ABOUT THIS CREDIT for further instruction for division of the total credit amount each business location ELECTRONIC IDENTIFICATION CARD READER Enter the amount of credit claimed (may not exceed $300 per business location) Enter the name and address of business owner partner or associate who is claiming the credit: (Go to "Division of Credit" on reverse side of this form if more than one owner) HOW TO CLAIM THIS CREDIT INCOME TAX CREDIT FOR INCOME TAX CREDIT FOR ELECTRONIC IDENTIFICATION CARD READER INT 12/2001 Location(s) of Eligible Business List the physical address of each business location using the electronic identification card readers If additional space is needed please attach a separate sheet Name and address Name and address Amount allowed $ Name and address Amount allowed $ Name and address Amount allowed $ Notary Public My commission expires partnership or association The total credit claimed by all members of the partnership or association may not exceed $300 for PURCHASE AND USE STATEMENT PURCHASE AND USE STATEMENT INSTRUCTIONS Purpose of Form Use Form RPD 41246 to claim an income tax credit for purchasing and using an electronic identification card reader 7 2 18 8 and 7 2A 18 NMSA 1978 See instructions on the reverse side of this form RPD 41246 Signature of claimant Date State of New Mexico Taxation & Revenue Department Subscribed and sworn before me this day of 20 tax return if: The amount of the credit is $300 for each business location using electronic identification card readers This non refundable credit must be claimed in the taxable year the equipment was purchased and put into use Excess Total amount allowed for the eligible business described on the front of this form (may not exceed $300 per location) Total allowed $ Under penalty of perjury I declare I have met the requirements for claiming this credit as set out in Section 7 2 18 8 or 7 2A 18 NMSA 1978 that I have examined the information I have supplied on this purchase and use statement and to the best of my knowledge and belief it is true correct and complete