Form Wc-1 - Workers Compensation Fee Return - Nm Taxation And Revenue Department
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1STATE OF NEW MEXICO
Taxation and Revenue Department
Workers Compensation Fee Return
Date: _____________________
FEIN: _____________________
WHO MUST FILE: Every employer who is covered by the Workers' Compensation Act is required to file and pay
the New Mexico Workers' Compensation Fee on Form WC-1 (pursuant to Section 52-5-19 NMSA 1978, as
amended in 1992). Each employer who receives a Form WC-1 must file a report. If you are not required to pay the
fee in this quarter, you must file a zero report.
WHEN TO FILE: The Form WC-1 is due on or before the last day of the month following the end of the calendar
quarter.
WHERE TO FILE: Send the Form WC-1 and check or money order payable to:
Taxation and Revenue Department P.O. Box 2527 Santa Fe, NM 87504-2527
Record Verification File:
1. Report for Qtr Ending:
A. Your Federal Employer ID Number (FEIN):
2. Number of Employees:
B. Your CRS ID Number is:
3. Assessment Fee:
$____________ __
C. Your Employer Account Number (EAN) is:
4. Penalty:
$____________ __
If these numbers are correct, no update action is required.
5. Interest:
$____________ __
If these numbers are incorrect, please enter the correct numbers
in A, B, or C below on Form WC-1.
6. Total:
$____________ __
↑ RETAIN THIS PORTION FOR YOUR RECORDS ↑
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please cut and include voucher with payment
1. Report for Qtr Ending:
2. Number of Employees:
3. Assessment Fee:
$____________ __
4. Penalty:
$____________ __
A. FEIN:
5. Interest:
$____________ __
B. CRS:
C. EAN:
6. Total:
$_______________ __
_______________
Signature:________________________________________________
Date:
Phone: ___________________________________________________
Check here if Amended return:
Mail voucher and payment payable to:
Taxation and Revenue Department
WKC
P.O. Box 2527
Santa Fe, NM 87504-2527
FORM: WC-1 Rev. 02/2003
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