Form RPD-41368 Notice of Distribution of Technology Jobs Tax Credit

Credit number of PTE: Approval date of PTE: Date of the transfer: Amount of technology jobs tax credit transferred: Form RPD 41368 Notice of Distribution of Technology Jobs Tax Credit must be used to report to the New Mexico Taxation and Revenue Department (TRD) a distribution of approved technology jobs tax credit from a pass through entity (PTE) to owners members or partners of the PTE This notice must be signed by the authorized representative of a PTE that has been approved for the technology jobs tax credit Notice should be mailed to TRD within 10 days of the transfer The PTE must have a TRD approved Form RPD 41239 Application for Technology Jobs Tax Credit before using this Form RPD 41368 to report a transfer Mail to New Mexico Taxation and Revenue Department PIT Edit Error P O Box 5418 Santa Fe New Mexico 87502 5418 For assistance completing this form call (505) 476 3683 Name of contact (if applicable) Phone number E mail address Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of owner member or partner SSN Amount Name of PTE SSN or FEIN Page 1 of Page of Purpose of this Form Technology jobs tax credit transferred: Transferred from: Transferred to: Under penalty of perjury I certify that I have examined this form and attachments and to the best of my knowledge and belief it is true correct and complete Signature of the PTE authorized representative Date