Form RPD-41324 Gross Receipts Tax Credit For Certain Hospitals

For report period beginning on or after But before Percentage of the hospital s taxable gross receipts after all applicable deductions have been taken July 1 2007 July 1 2008 1% July 1 2007 July 1 2008 755% July 1 2008 July 1 2009 1 51% July 1 2008 July 1 2009 2% July 1 2009 July 1 2010 2 265% July 1 2009 July 1 2010 3% July 1 2010 July 1 2011 3 02% July 1 2010 July 1 2011 4% July 1 2011 3 775% July 1 2011 5% taxable gross receipts after all applicable deductions have been taken 1 Municipality / County Name 2 Enter the Taxable Gross Receipts (Column F) 3 Enter the percentage applicable for the report period of this claim and the location of the hospital (see instructions) 4 Multiply Column 2 by percentage rate in Column 3 1) for a hospital located in a municipality; and 2) for a hospital located in the Add all amounts in Column 4 and enter the sum in the TOTAL block This is the credit available Column 1: Enter the location of the hospital (municipality and/or unincorporated area of a county) Column 2: Enter the amount from Column F of your CRS 1 report for the current report period Column 3: Enter the percentage rate from the charts in the instructions of the credit applicable to this report period Column 4: Multiply the amount reported in Column 2 by the percentage rate in Column 3 and enter the product in Column 4 For assistance call (505) 476 3683 or your local district office For report period beginning But before Percentage of the hospital s on or after GROSS RECEIPTS TAX CREDIT FOR CERTAIN HOSPITALS GROSS RECEIPTS TAX CREDIT FOR CERTAIN HOSPITALS CLAIM FORM Hospital means a facility providing emergency or urgent care inpatient medical care and nursing care for acute illness injury surgery or obstetrics and includes a facility licensed by the Department of Health as a critical access hospital general hospital long term acute care hospital psychiatric hospital rehabilitation hospital limited services hospital and special hospital HOW TO COMPLETE THIS FORM: Complete all information requested in the business name block above The reported tax period must match the tax period shown on the CRS 1 return Compute the credit amount on the worksheet below and attach to the New Mexico CRS 1 Long Form Submit the CRS 1 Long Form and Form RPD 41324 Gross Receipts Tax Credit for Certain Hospitals Claim Form on or before the due date of the return Do not reduce the tax liability shown on the CRS 1 Long Form by the credit claimed Underpay the liability due on the report by the amount of the cedit to be applied Mail to New Mexico Taxation and Revenue Department P O Box 25128 Santa Fe New Mexico 87504 25128 HOW TO COMPLETE THIS FORM: Complete all information requested in the business name block The reported tax period must match the tax period shown on the CRS 1 Column 1: Enter the location of the hospital (municipality and/or unincorporated area of a county) Column 2: Enter the amount from Column F of your CRS 1 report for the current report period Column 3: Enter the percentage rate from tables above of the credit applicable to this report period Column 4: Multiply the amount reported in Column 2 by the percentage rate in Column 3 and enter the product in Column 4 Add all amounts in Column 4 and enter the sum This is the credit available I declare that I have examined this return including any accompanying schedules and statements and to the best of my knowledge and belief it is true correct and complete INSTRUCTIONS MM/DD/YYMM/DD/YY through Enter the report period as shown on the attached CRS 1 return Name and phone number of contact Name of business New Mexico CRS Identification Number Signature of Taxpayer or Agent Title Date State of New Mexico Taxation and Revenue Department TOTAL unincorporated area of a county WHO MUST FILE THIS FORM: For report periods beginning on or after July 1 2007 hospitals licensed by the New Mexico Department of Health may claim a gross receipts tax credit equal to a percentage of taxable gross receipts See rates below WHO MUST FILE THIS FORM: For report periods beginning on or after July 1 2007 hospitals licensed by the New Mexico Department of Health may claim a gross receipts tax credit equal to a percentage of taxable gross receipts See the instructions for the table of credit rates