Form RPD-41336 Notice of Transfer of Land Conservation Incentives Credit

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