Form Wc-1 - Taxation And Revenue Department

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STATE OF NEW MEXICO
RPD-41054
Rev. 10/2006
TAXATION AND REVENUE DEPARTMENT
FORM WC-1 - WORKERS' COMPENSATION FEE RETURN
Beginning with calendar quarter ending September 30, 2004, the quarterly worker's compensation fee paid on
Form WC-1 increases from $4 to $4.30 per covered worker (employee). Only the employer's share increases.
See the instructions for details.
WHO MUST FILE: Every employer who is covered by the Workers' Compensation Act, whether by requirement or election, must
file and pay the New Mexico Worker's Compensation Fee and file Form WC-1. See the instructions for requirements.
* IMPORTANT: In Line 1, enter the number of workers (employees) to whom the Workers' Compensation Fee applies. This is
the number of covered employees you employed on the last working day of the calendar quarter. If you have no covered employees,
enter zero.
WHEN TO FILE: The workers' compensation fee is due on or before the last day of the month following the close of the report
period. A report period is a calendar quarter, ending March 31, June 30, September 30 and December 31.
Make the check or money order payable to Taxation and Revenue Department. Mail the bottom portion of this form with payment
to New Mexico Taxation and Revenue Department, P.O. Box 2527, Santa Fe, NM 87504-2527. Retain the top portion for your
records. For assistance call (505) 827-2632.
REPORT PERIOD:
A FEIN:
Beginning (mm-dd-yy)
Ending (mm-dd-yy)
B CRS:
1. *No. of covered workers
C EAN:
1.
at close of report period
NAME:
$
2. Assessment fee
2.
$
3. Penalty
STREET/BOX:
3.
$
4. Interest
4.
CITY, STATE, ZIP:
$
5. Total due
5.
PLEASE CUT AND INCLUDE THE BOTTOM PORTION WITH YOUR PAYMENT
RETAIN THE UPPER PORTION FOR YOUR RECORDS
WORKERS' COMPENSATION FEE (WC-1)
REPORT PERIOD:
A FEIN:
Beginning (mm-dd-yy)
Ending (mm-dd-yy)
B CRS:
1. *No. of covered workers
C EAN:
1.
at close of report period
NAME:
$
2. Assessment fee
2.
$
3. Penalty
3.
STREET/BOX:
$
4. Interest
4.
CITY, STATE, ZIP:
$
5. Total due
5.
Check if amended
Signature _________________________________________ Phone ______________ Date ________________
WKC
Mail To:
Taxation and Revenue Department, P.O. Box 2527, Santa Fe, NM 87504-2527

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