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State of New Mexico - Taxation & Revenue Department

RPD-41281

Rev. 12/14/2011

Job Mentorship Tax Credit Claim Form

Schedule A

Attach Schedule A to RPD-41281, Job Mentorship Tax Credit Claim Form, if you have unused Job Mentorship Tax credit

available for carry forward from prior years, or your total available credit can be claimed by one or more owners, partners

or associates.

Worksheet to calculate the total unused credit available for carry forward from prior years

(a) Tax year of previously allowed credit. Enter the tax year for each credit allowed in a previous tax year. Do not include

any credit allowed for a tax year more than three years prior to the current tax year. Enter the tax year if the credit was al-

lowed for a full calendar year. For fiscal-year and short-year returns, enter the beginning and ending dates of the tax year.

For example, enter 2003 if the tax year is a calendar year, or enter July 1, 2002 to June 30, 2003, if the tax year is a fiscal

year.

(b) Credit allowed in the previous tax year. For each credit allowed in a previous tax year listed in column (a), enter the

total amount of credit allowed for the business as indicated on line 4 of the Form RPD-41281 filed for that year.

(c) Total credit claimed in previous tax years. For each credit allowed in a previous tax year listed in column (a), enter the

total amount of credit claimed by all owners, partners or associates eligible to claim the Job Mentorship Tax Credit available.

Include credit claimed in all previous tax years. For each tax year, current-year credits are applied before applying carry

forward credits.

(d) Unused credit available for carry forward from prior years. Subtract column (c) from column (b). Enter the sum of all

amounts in column (d) on line 5 of the current year claim form, RPD-41281.

(a) Tax year of

(b) Credit allowed in

(d) Unused credit for available for

previously allowed credit

previous tax year

previous tax years

carry forward [(b) - (c)]

Division of the Total Available Credit Report

If the Job Mentorship Tax Credit for the New Mexico business is divided among two or more owners, partners or associates,

complete the following information for each eligible owner, partner, or associate below. Enter the name and address of all

business owners, partners or associates eligible to claim a portion of the total Job Mentorship Tax Credit available to be

claimed in the current tax year. Enter the federal employer identification number (FEIN) or the social security number (SSN)

used to file each owner’s, partner’s or associate’s New Mexico income tax return. Enter the percentage which represents

the owner’s, partner’s or associate’s interest in the partnership, limited partnership, limited liability company, S corporation

or other business association. If additional space is needed, attach a separate schedule.

FEIN or SSN

Percentage of interest

Name and address of owner, partner or associate

FEIN or SSN

Percentage of interest

Name and address of owner, partner or associate

Percentage of interest

FEIN or SSN

Name and address of owner, partner or associate

FEIN or SSN

Percentage of interest

Name and address of owner, partner or associate

FEIN or SSN

Percentage of interest

Form Rpd-41281 - Job Mentorship Tax Credit Claim Form - State Of New Mexico Taxation And Revenue Department Page 2

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