Form Asd - 22240 - Application For Resident Contractor Certification (Page 2 of 4) in pdf

Form Asd - 22240 - Application For Resident Contractor Certification Page 2

Previously Certified Contractor or a Contractor Previously Eligible for Certification

The contractor is licensed as a contractor in New Mexico; and

After January 1, 2012, but less than three years ago, the contractor obtained and was eligible for resident contractor

certification. However, the contractor has since: (1) changed its name; (2) reorganized into one or more different legal

entities; or (3) been purchased by or merged with another legal entity, but now operates in New Mexico as substan-

tially the same commercial enterprise;

After January 1, 2012, but less than three years ago, the contractor applied and was eligible for resident contractor

certification. However, before the Department was able to issue certification, the business: (1) changed its name; (2)

reorganized into one or more different legal entities; or (3) was purchased by or merged with another legal entity, but

now operates in New Mexico as substantially the same commercial enterprise.

Affidavit

SECTION III

AFFIDAVIT FROM CERTIFIED PUBLIC ACCOUNTANT

I hereby swear, under oath that it is my professional opinion that the applicant

STATE OF __________________

meets the required criteria set forth in NMSA 1978, Section 13-1-22 (D) (2012)

for Resident Contractor Certification and that ALL information provided and

COUNTY OF ________________

ALL checkedmarked statements in the foregoing application are true and com-

plete to the best of my knowledge.

Name

Date

State

CPA License #

Signature

NOTARY

Subscribed and sworn to before me this __________ day of _________________________, 20_________ .

Notary Public _____________________________

My Commission Expires __________________

(NOTARY SEAL)

I am authorized to sign this application on behalf of the applicant and attest to the

truthfulness of the information provided herein.

Signature of Applicant

Date

Taxation and Revenue Department

Send completed

application along

PO Box 5374

with $35.00 to:

Santa Fe, NM 87502-5374

(505) 827-0951

Form Asd - 22240 - Application For Resident Contractor Certification Page 2