Affordable Housing Tax Credit Transfer Form Page 2
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1
2Assignee
Name of Assignee:
Contact Person:
Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail
Please complete the section below that describes your filing status at the time the contribution was made
1.)
A Corporation filing New Mexico Corporate Income and Franchise tax return (Form CIT)
Corporation name:__________________________________CRS ID No.:_________________FEIN:_____________
An entity filing New Mexico Income and Information Return for Pass-through Entities (Form PTE)
2.)
(Complete pass-through entity information below, attach an additional sheet if necessary to include all members, partners, or shareholders)
Business name and owner:__________________________CRS ID No.:__________________FEIN:_____________
3.)
An individual or entity filing a New Mexico Fiduciary Return (Form FID)
Individual name:_______________________________________FEIN:____________________________________
4.)
A business or corporation filing New Mexico Combined Report System Return (Form CRS-1)
Business name and owner:___________________________CRS ID No.:__________________________________
5.)
An individual filing New Mexico Personal Income Tax Return (Form PIT-1)
Individual name:______________________________________SSN:_____________________________________
6.)
An eligible company filing NM Enhanced 911 Services Surcharge Return (Form RPD-41114)
Company name:______________________________________CRS ID No.:_______________________________
7.)
A telecomunications company filing NM Telecommunication Relay Service Surcharge Return (Form RPD-41116)
Company name:______________________________________CRS ID No.:_______________________________
Pass-through Entity Information
(attached additional sheets as needed if any entity listed below is also a pass-through entity)
Name(s)
Social Security Numbers
% Ownership
%
%
%
%
%
%
Certification
• I certify that I am an authorized representative of the Assignee and as such am authorized to
make the statement of affirmation contained herein.
•I certify under penalties of perjury that the above statements, information contained in this document and
attachments are complete, true, and correct to the best of my knowledge and belief.
Assignee Signature
Title
Print Name
Date
Notarized Statement
)
State of New Mexico
)ss
)
County of__________________City of_____________________
This instrument acknowledged before me this_____ day of _______________, 20__,
by______________________________as___________________________________
of____________________________________________________________________
My Commision expires_______________________
___________________________
Notary Public
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