Form RPD-41247 Certificate of Eligibility for the Rural Job Tax Credit

Eligible Employee means any individual other than an individual who: Qualifing Period means the 12 months starting on the first day of an eligible employee s working in a qualifying job or 12 months starting on the anniversary of the day the eligible employee begins working in a qualifying job (1) through (8) of the 26 U S C Section 152(a) to a grantor beneficiary or fiduciary of the estate or trust or 5 the person employed in this qualified period is an eligible employee as defined in 7 2E 1 1 NMSA 1978 (see reverse) 6 wages paid to the eligible employee during this qualified period were: $ 7 number of weeks during the qualifying period (see reverse) that the position was occupied : 8 the qualifying job is located in a: tier one tier two area (See reverse for definition ) a four qualifying periods for each job performed or ABOUT THIS CREDIT Attach this form to Form RPD 41238 Application for Rural Job Tax Credit and mail to: Taxation and Revenue Depart ment ATTN: Director s Office P O Box 8485 Albuquerque NM 87198 8485 b two qualifying periods for each job performed or based at a location in a tier one area based at a location in a tier two area bears any of the relationships described in Para graphs (1) through (8) of the 26 U S C Section 152(a) to the employer or if the employer is a corporation to an individual who owns directly or indirectly more than 50% in value of the outstanding stock of the corporation or if the employer is an entity other than a corporation to any individual who owns directly or indirectly more than 50% of the capital and profits interest in the entity; c is a dependent as that term is described in 26 CERTIFICATE OF ELIGIBILITY FOR THE RURAL JOB TAX CREDIT Certify that an eligible employee has occupied this job for at least 48 weeks of this period Certify that the employee(s) who is occupying the job during this period meets the definition of eligible employee below Certify the wages paid to the eligible employee(s) occupy ing the qualifying job for the qualified period Enter the lower of either the total wages paid to the employee or $16 000 The maximum that may be claimed is $16 000 per qualifying job per qualifying period Certify whether the job is performed or based at a location Complete all information requested in the address block An eligible employer is an employer in a tier one or tier two area (see below) who has been approved for in plant training as sistance by the Economic Development Department pursuant to Section 21 19 7 NMSA 1978 Eligible Employee Defined: Eligible employers may earn the rural job tax credit for each qualifying job created after July 1 2000 The holder of the credit may apply all or a portion of the rural job tax credit to gross receipts (excluding tax imposed by a municipality or county) compensating and withholding taxes due The holder also may apply the credit to personal or corporate income taxes due See Form 41238 Application for Rural Job Tax Credit for further details Enter the date the qualifying job was created The qualify ing job must have been created after July 1 2000 Enter the name of the eligible employee(s) occupying the qualifying job If more than one employee occupied the job dur ing the qualified period include the names of each employee Enter the number of previous qualified periods claimed for this job The rural job tax credit may be claimed a maximum of: Enter the qualifying period for which this credit is claimed See the definition of Qualifying Period below For the status of the credit application call (505) 841 6478 HOW TO COMPLETE THIS FORM How to File this Form To apply for the Rural Job Tax Credit complete Form RPD 41238 Application for Rural Job Tax Credit Attach Form RPD 41247 Certificate of Eligibility for the Rural Job Tax Credit for each qualified job in the eligible period claimed Summarize the total eligible jobs and the wages on Form RPD 41238 Application for Rural Job Tax Credit Submit all documentation to the Taxation and Revenue Department for approval Once the credit is approved you will receive notification from the Department See the instructions for Form RPD 41238 Application for Rural Job Tax Credit for further details I certify that: I certify that: (Mark the boxes that apply and complete the required information ) if the employer is an estate or trust is a grantor beneficiary or fiduciary of the estate or trust or is an individual who bears any of the relationships described in Paragraphs in a tier one or a tier two area INSTRUCTIONS FOR CERTIFICATE OF ELIGIBILITY FOR THE RURAL JOB TAX CREDIT Mailing address City state and ZIP code Name of contact Phone number Fax number Name of eligible employee(s) : Name of eligible employer New Mexico CRS identification number Notary Public My commission expires Physical address City state and ZIP code Purpose of Form Form RPD 41247 is to be used by a qualified employer to supplement a claim for the Rural Job Tax Credit This form certifies the wages of an eligible employee during a qualified period for a qualified job See the instructions for important definitions Qualifying Period Defined: Signature of claimant Date State of New Mexico Taxation & Revenue Department Subscribed and sworn before me this day of 20 The date the qualifying job was created: The number of qualified periods previously claimed for this qualifying job: The qualifying period for this certificate is: through (mmyy) (mmyy) This credit is not available for jobs performed or based in Los Alamos County the cities of Albuquerque Los Ranchos Corrales Rio Rancho Tijeras Santa Fe Las Cruces or Farmington or within 10 road miles of any of these cities Tier two areas are Roswell Clovis Carlsbad Hobbs Gallup and Alamogordo Tier one area is anywhere within New Mexico not listed above Effective June 3 2003 Farmington and the 10 miles surrounding this city no longer qualified for the rural job tax credit Tier Areas Defined: To qualify all of the following certifications must be met Check the applicable boxes on the form U S C Section 152(a)(9) of the employer or if the taxpayer is a corporation of an individual who owns directly or indi rectly more than 50% in value of the outstanding stock of the corporation or if the employer is an entity other than a corporation of any individual who owns directly or indirectly more than 50% of the capital and profits interests in the entity or if the employer is an estate or trust of a grantor beneficiary or fiduciary of the estate or trust Under penalty of perjury I declare that I have examined this claim and to the best of my knowledge and belief it is true correct and complete