Form Rpd-41116 - Telecommunications Relay Service Surcharge Return
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1
2State of New Mexico
RPD-41116
Rev. 07/2010
Taxation and Revenue Department
TELECOMMUNICATIONS RELAY SERVICE SURCHARGE RETURN
WHO MUST FILE: Every telecommunications company, including mobile telecommunications (cellular service) compa-
nies, providing intrastate telephone services (ITS) must assess, collect and remit the telecommunications relay service
surcharge to the Taxation and Revenue Department. Telecommunications companies should assess the surcharge of
thirty-three hundredths of one percent (.33%) on all intrastate calls (see the definitions in the instructions) and include
the amount of the surcharge on the monthly bills to their customers. Customers should pay the surcharge at the time
of payment of the monthly bill.
WHEN TO FILE: The Telecommunications Relay Service Surcharge is due on or before the 25th day of the month
following the close of the reporting period in which the Telecommunications Relay Service Surcharge was collected. A
reporting period is from the first day of the month to the last day of the calendar month.
Make the check or money order payable to Taxation and Revenue Department. Mail only the bottom portion of this
form and the payment to:
New Mexico Taxation and Revenue Department
P.O. Box 25123
Santa Fe, NM 87504-5123
Retain the top portion for your records. For assistance call (505) 827-0762.
REPORT PERIOD:
FEIN:
Beginning (mm-dd-yy)
Ending (mm-dd-yy)
CRS:
NAME:
1.
Gross collection for ITS
1.
$
2.
Total surcharge
(line 1 x 0.0033)
2.
$
STREET/BOX:
3.
Penalty
3.
$
CITY, STATE, ZIP:
4.
Interest
4.
$
5.
Total due
5.
$
BOTTOM PORTION WITH YOUR PAYMENT
RETAIN THE UPPER PORTION FOR YOUR RECORDS
TELECOMMUNICATIONS RELAY SERVICE SURCHARGE
FEIN:
REPORT PERIOD:
Beginning (mm-dd-yy)
Ending (mm-dd-yy)
CRS:
NAME:
1.
Gross collection for ITS
1.
$
STREET/BOX:
Total surcharge
2.
(line 1 x 0.0033)
2.
$
CITY, STATE, ZIP:
3.
Penalty
3.
$
4.
Interest
4.
$
$
5.
Total due
5.
Signature _______________________________________ Date ______________ Phone ____________________
Check if amended
E-mail address ____________________________________________________________
TRS
Mail to: Taxation & Revenue Department, P.O. Box 25123, Santa Fe, NM 87504-5123
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