a land conservation tax credit as set out in Section 7 2 18 10 or 7 2A 8 9 NMSA 1978 I declare that I have examined the information and attachment and to the best of my knowledge and belief it is true correct and complete
another taxpayer This notice must be signed by the qualified intermediary and notarized Notice must be mailed to TRD
Date of the transfer:
Form RPD 41336 Notice of Transfer of Land Conservation Incentives Tax Credit must be used by a qualified intermediary to report to the Taxation and Revenue Department (TRD) a transfer of approved land conservation incentives tax credit to
Land Conservation Incentives tax credit sold exchanged or transferred:
Mailing address City state and ZIP code
Name of contact Phone number E mail address
Name of holder SSN or FEIN
Name of qualified intermediary Phone number E mail address
Notary Public My commission expires
Notice of Transfer of Land Conservation Incentives Tax Credit Purpose of this Form
Original credit number: New credit number: Date of qualified donation: Amount of land conservation incentives tax credit transferred:
P O Box 5418 Santa Fe New Mexico 87504 5418 For assistance completing this form call (505) 476 3683
Qualified Intermediary:
Rev 02/2011
RPD 41336
Signature of qualified intermediary Date
State of New Mexico Taxation and Revenue Department
Subscribed and sworn before me this day of 20
Sworn statement of qualified intermediary
Transferred from:
Transferred to:
Under penalty of perjury I declare I have met the requirements as a qualified intermediary and am reporting the transfer of
within 10 days of a sale exchange or other transfer Mail to New Mexico Taxation and Revenue Department PIT Edit Error
