Buyer Registration Form - 2015 printable pdf download

Buyer Registration Form - 2015

Buyer Registration Form

New Mexico Land Conservation Incentives Tax Credits

For 2015 Tax Year

Tax Credit Buyer

Name(s)_______________________________________________________________________

Type of Entity

__________________________________

(Individual, Corporation, Partnership, LLC, Trust, etc.)

Address_______________________________________________________________________

City/State/Zip __________________________________________________________________

Phone__________________Fax___________________Email____________________________

Social Security Number or Federal Employer Identification Number ___________________

Value of conservation easement tax credits you wish to purchase for tax year 2015 $_________

(Tax credits can be purchased in any amount starting at $10,000)

Accountant’s Name _____________________________________________________________

Address_______________________________________________________________________

City/State/Zip __________________________________________________________________

Phone__________________Fax___________________Email____________________________

Administrative use only

R__________________

S______________________________________________________________

O:__________________________________________________________________________________________________

2919 W. 17

Avenue, Ste. 201 Longmont, CO 80503 • 303-774-8195 • fax 720-302-0447

Buyer Registration Form - 2015