Combined Report Form, Crs-1 Short Form
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1
2-----------------------------------------
CRS-l
New Mexico Taxation and Revenue Department
Rev. 03/2005
COMBINED REPORT FORM, CRS-1 Short Form
TAXPAYERWS COPY
A
Municipality
1
County
Name
B~ecial
ode'
C
Location
Code
D
Gross Receipts
(Excluding Tax)
E
Total
Deductions
F
Taxable Gross
Receipts
G
Tax
Rate
H
Gross Receipts
Tax
01-123
0.0818575
01-123
0.0818575
0.0818575
,t
ana
H.
$
'See
instructioos for column
B.
Payment made by:O
Automated Clearinghouse Deposit
0
Federal Wire Transfer
Check
if
applicable: 0 Amended Report
$
Date
Date
TOTAL GROSS RECEIPTS TAX
COMPENSATING TAX
WITHHOLDING TAX
TOTAL TAX DUE
1
2
3
4
TAX PERIOD
Print
Name
U-LJ
through
Month
Day
Year
NM CRS
10
No.
U-LJ
Month
Day
Year
Phone
No.
PENALTY
If
filed after 9/25/08
INTEREST
If
filed after 9/25108
TOTAL AMOUNT DUE
5
6
7
Signature of Taxpayer or Agent
Title
Date
_
I declare that I have examined this retum including any accompanying schedules and statements, and to the best of my knowledge and belief,
it
is true, correct and complete.
vRETURN BOTTOM PORTION WITH YOUR PAYMENT V
A
Municipaltty
1
County
Name
B~ecial
ode'
C
Location
Code
D
Gross Receipts
(EXcluding Tax)
E
Total
Deductions
F
Taxable Gross
Receipts
G
Tax
Rate
H
Gross Receipts
Tax
01-123
0.0818575
01-123
0.0818575
0.0818575
U,
t
ana
H
$
'See
instructions for column B.
Payment made by: 0
Automated Clearinghouse Deposit
0
Federal Wire Transfer
Check
if
applicable:
o
Amended Report
Date
Date
$
TOTAL GROSS RECEIPTS TAX
COMPENSATING TAX
WITHHOLDING TAX
TOTAL TAX DUE
1
2
3
4
TAX PERIOD
Print
Name
U-LJ
through
Month
Day
Year
NM CRS
10
No.
U-LJ
Month
Day
Year
Phone
No.
PENALTY
If
filed after 9/25108
INTEREST
If
filed after
9/25/08
TOTAL AMOUNT DUE
5
6
7
Signature of Taxpayer or Agent
Tnle
Date
_
I declare that I have examined this retum including any accompanying schedules and statements, and to the best of my knowledge and belief,
it
is true, correct and complete.
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