Form Crs-1 - Combined Report Form - 2016 Page 2
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B
C
D
E
F
G
H
A
Municipality / County
Special
Location
Gross Receipts
Total
Taxable Gross
Tax
Gross Receipts
Code*
(Excluding Tax)
Deductions
Receipts
Rate
Tax
Name
Code
TOTAL COLUMNS D, E and H.
$
$
1
TOTAL GROSS RECEIPTS TAX
*See instructions for column B.
Payment made by:
Automated Clearinghouse Deposit
Date _________________
COMPENSATING TAX
2
Federal Wire Transfer
Date _________________
3
WITHHOLDING TAX
Check if applicable: Amended Report
4
TOTAL TAX DUE
TAX PERIOD
PENALTY
5
through
INTEREST
6
Month
Day
Month
Day
Year
Year
Print
NM CRS
Phone
TOTAL AMOUNT DUE
7
Name ________________________ ID No. _____________________ No. _________________
Rev. 10/2014
I declare that I have examined this return including any accompanying schedules and statements, and to the best of my knowledge and belief, it
is true, correct and complete.
Signature of taxpayer or agent _______________________ Title _____________ Date ____________ E-mail address ___________________
A
B
C
D
E
H
F
G
Municipality / County
Special
Location
Gross Receipts
Taxable Gross
Tax
Gross Receipts
Total
Name
Code*
Code
(Excluding Tax)
Receipts
Rate
Tax
Deductions
TOTAL COLUMNS D, E and H.
$
$
1
TOTAL GROSS RECEIPTS TAX
*See instructions for column B.
Payment made by:
Automated Clearinghouse Deposit
Date _________________
2
COMPENSATING TAX
Federal Wire Transfer
Date _________________
3
WITHHOLDING TAX
Check if applicable: Amended Report
4
TOTAL TAX DUE
TAX PERIOD
PENALTY
5
through
6
INTEREST
Month
Day
Month
Day
Year
Year
Print
NM CRS
Phone
TOTAL AMOUNT DUE
7
Name ________________________ ID No. _____________________ No. _________________
Rev. 10/2014
I declare that I have examined this return including any accompanying schedules and statements, and to the best of my knowledge and belief, it
is true, correct and complete.
Signature of taxpayer or agent _______________________ Title _____________ Date ____________ E-mail address ___________________
17
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