Form RPD-41249 Notice of Approval of a Qualified Employer

A copy of this approved form is to be given to nonresident employees at qualifying New Mexico plant locations by a qualified employer Department approval must be obtained prior to delivery to the nonresident employee Calendar Year 2012 page 1 of 2 Calendar Year 2012 page 2 of 2 for Allocation of Nonresident Employee Income from Manufacturing Plants in New Mexico Within 20 Miles of How withholding tax requirements are affected: New Mexico employers must withhold from wages of New Mexico resi dents if required to withhold for federal purposes New Mexico also requires withholding from the wages of any nonresident employee who has worked in New Mexico for a total of 15 days in a calendar year and who is subject to a federal withhold ing requirement Once a manufacturing plant is approved as qualified the nonresident employees of that plant may elect to allocate or apportion the wages earned at the qualified manufacturing plant to the state of residency The federal income tax withholding will not be affected by this election but the employee may wish to change his or her withholding for state purposes The employee may contact the employer about a change in New Mexico withholding only When the employer s qualified period has expired the employee should review his or her New Mexico withholding requirements because the income earned at the plant will then be subject to New Mexico income tax The New Mexico Taxation and Revenue Department will perform random audits of persons filing this form Notice of Approval of a Qualified Employer for Allocation of Nonresident Employee Income from Manufacturing Plants in New Mexico Within 20 Miles of International Border You may be asked to verify your residency status I swear under penalty of perjury that I am a nonresident employee of a New Mexico qualified employer employed at the above plant location I further declare that I have examined this document including accompanying statements and to the best of my knowledge and belief it is true correct and complete Name of Nonresident Employee (please print your name) Instructions for the nonresident employee: In tax year 2012 employees who are not residents of New Mexico and who are employed at an approved plant may allocate income earned at the plant to their state of residence for state income tax purposes The election applies only to income earned at the business location specified on page 1 of this form Other income from New Mexico sources must be allocated and apportioned to New Mexico For example wages earned from employ ment at a New Mexico business that has not been approved or otherwise does not qualify as an eligible employer must be allocated to New Mexico Income from all other New Mexico sources must be allocated to New Mexico Maintain a copy of this form in your records and submit a copy with your New Mexico personal income tax (PIT 1) return International Border (Section 7 2 11 NMSA 1978) Name of Qualified Employer New Mexico Taxation and Revenue Department Use Only Notice of Approval of a Qualified Employer Physical Address of the Qualified Manufacturing Plant City/ State/ ZIP Purpose: The business listed below is approved as a qualified employer for calendar year 2012 This form serves as notice to the employee of the approval and it must be retained in the employee s records For each year that a business qualifies employees who are not residents of New Mexico may choose to allocate or apportion income earned at the qualified manu facturing plant to their state of residence Only income earned by a nonresident of New Mexico at an approved business location may qualify for these special allocation and apportionment procedures All other New Mexico source income must be allocated to New Mexico Signature of Department Employee Title Date Signature of Nonresident Employee Date State of New Mexico Taxation and Revenue Department The business described herein has been approved by the Taxation and Revenue Department as a Qualified Employer for calendar year 2012 for purposes of Section 7 2 11 NMSA 1978 This section is to be completed by the New Mexico Taxation and Revenue Department This section is to be completed by the nonresident employee To allocate income earned at the qualified business location to your state of residence you must file a PIT B schedule with your New Mexico PIT 1 Personal Income Tax return Report all income from wages everywhere on PIT B line 1 column 1 When completing line 1 column 2 exclude the wages earned at the qualified manufacturing plant Continue to complete the Schedule PIT B as per the instructions provided with that form IMPORTANT: Submit a copy of Form RPD 41249 12 with your New Mexico income tax return to document that no New Mexico income tax is due from your employment at this plant