Form Acd - 31015 - Applicaton For Business Tax Identification Number

State of New Mexico - Taxation and Revenue Department

ACD - 31015

Rev.

12/14

APPLICATON FOR BUSINESS TAX IDENTIFICATION NUMBER

PLEASE TYPE OR PRINT IN BLACK INK - Please read instructions on reverse

N E W

M E X I C O

For Office Use Only

DATE ISSUED

FORM(S) SENT ELECTRONICALLY

NM TRD ID# 0______-_________________-00-_____

o YES

o NO

1. BUSINESS NAME

2. DBA

7. Type of Ownership (check one)

3. Federal ID No.

Corporation

Non Profit Organization

q

q

Required except for individual/Proprietorship/Sole Owner

Estate

Exempt 501 (c) ____________

q

Government

Partnership

q

q

4. Telephone - Business

(

)

Indian Tribe

q General q Limited

q

Individual / Proprietorship / Sole Owner

S Corporation

q

q

5. Other

(

)

Limited Liability Corporation (LLC)

Trust

q

q

Single Member (LLC)

q

6. Business E-mail Address

8. Mailing Address

City

State

Zip Code

9. Principal Business Location

City

State

Zip Code

10. Date business activity started or is anticipated to start in New Mexico

11. Date business will close (only if you check “Temporary” in Box 12)

Month

Day

Year

Month

Day

Year

12. Select CRS Filing status

13. A. Will business pay wages to employees in New Mexico?

Yes q

q

No

Monthly

Quarterly q

Semiannual

q

q

13. B. Will business be required to obtain

Worker’s Compensation Insurance within 12 months

q Yes

q No

Temporary q

Seasonal*

q

:

*If Seasonal, indicate month(s) in which you will file

Effective date

14. List Owners, Partners, Corporate Officers, Association Members or Shareholders. If listing a business other than an individual, please see instructions on back of yellow page.

(Attach additional pages if necessary.)

SSN / ITIN / FEIN

SSN / ITIN / FEIN

(required)

(required)

Name & Title

Name & Title

Home Address

Home Address

Phone

Phone

E-mail

E-mail

15. Method of accounting

16. Liquor License Type and Number

17. Secretary of State Business ID Number

18. Contractor’s License Number

Cash

Accrual

q

q

19. Will business sell Gasoline?

Yes q

No

23. Will business engage in Severing Natural Resources?

Yes

No

q

q

q

20. Will business sell Special Fuels?

Yes q

No

24. Will business engage in Processing Natural Resources?

Yes

No

q

q

q

21. Will business sell Cigarettes?

Yes q

No

25. Will business be a Water Producer?

Yes

No

q

q

q

22. Will business sell Tobacco Products?

Yes q

No

26. Will business be involved in Gaming Activities?

Yes

No

q

q

q

NOTE: If you answered Yes to any of the above, except Gaming Activities, please complete a form RPD 41218 Registration for Special Tax Programs.

27. If applicable, provide former owner’s

28. Are you operating any other business(es) in New Mexico q

Yes

No

q

NM TRD ID No.

If yes, give NM TRD ID No.

Business Name

Business Name

29. Primary type of business in NM (Check all that apply)

30. Give a brief description of nature of business

Accommodation, Food Services, and Drinking Places

Manufacturing

q

q

Administrative and Support Services and

Mining and Oil and Gas Extraction

q

q

Waste Management and Remediation Services

Professional, Scientific and Technical Services

q

Agriculture, Forestry, Fishing and Hunting

Real Estate and Leasing of Real Property

q

q

Arts, Entertainment and Recreation Management

Rental and Leasing of Tangible Personal

q

q

Construction

Property

q

Educational Services

Retail Trade

q

q

Finance and Insurance

Transportation and Warehousing

q

q

Government

Utilities

q

q

Health Care and Social Assistance

Wholesale Trade

q

q

Information

Other Services

q

q

31. I declare that the information reported on this form and any attached supplement(s) is true and correct.

Print Name

Title

Date

Signature