Form RPD-41335 Application for Land Conservation Incentives Credit

claimed a tax credit pursuant to the Land Conservation Incentives Tax Credit (Sections 7 2 18 10 and 7 2A 8 9 NMSA 1978) Holder if other than eligible donor If the eligible donor is a pass through entity passing the credit to a member(s) manager(s) partner(s) shareholder(s) or beneficiary(ies) complete the next section and submit a Form RPD 41335 Land Conservation Incentives Tax Credit Application for each member manager partner shareholder or beneficiary See the instructions I certify that I will not claim a credit pursuant to a similar law for costs related to donations for which I Land Conservation Incentives Tax Credit Application Land conservation incentives tax credit is granted by a delegate of the Secretary of the New Mexico Taxation and Revenue Department to the named holder indicated above Land conservation incentives tax credit is not granted An explanation is attached Signature of authorized delegate: Date of issuance: Name (please print): Title: TO BE COMPLETED BY THE TAXATION AND REVENUE DEPARTMENT Credit number: Approved amount of land conservation incentives tax credit: Date of qualified donation: Mailing address City state and ZIP code Name of contact Phone number E mail address Name of eligible donor Social security or federal employer identification number Name of holder if other than eligible donor Social security or federal employer identification number Percentage of interest in the entity of the eligible donor Amount of land conservation incentives tax credit to be granted qualifies as a donation of land eligible for the land conservation incentives tax credit The attached certificate of eligibility for the land conservation incentives tax credit issued by EMNRD authorizes TRD to approve and allow land conservation incentives tax credits to be applied to the holders personal corporate or fiduciary income tax liability Rev 04/2008 RPD 41335 State of New Mexico Taxation and Revenue Department Statement of applicant EMNRD has determined that the conveyance of property performed by the above named donor This form is required to be completed and submitted to the Taxation and Revenue Department (TRD) to obtain approval for the land conservation incentives tax credit Once approved this form will be returned to you and you can begin to claim the credit Attach a copy of the certificate of eligibility for the land conservation incentives tax credit issued by the New Mexico Energy Minerals and Natural Resources Department (EMNRD) For assistance completing this form call (505) 476 3683 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 Signature of applicant Date