Form Rpd-41324 - Gross Receipts Tax Credit For Certain Hospitals Claim Form - State Of New Mexico Taxation And Revenue Department

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RPD-41324
State of New Mexico - Taxation and Revenue Department
Rev. 02/2011
GROSS RECEIPTS TAX CREDIT FOR CERTAIN HOSPITALS CLAIM FORM
WHO MUST FILE THIS FORM: For report periods beginning on or after July 1, 2007, hospitals licensed by the New
Mexico Department of Health may claim a gross receipts tax credit equal to a percentage of taxable gross receipts. See
the instructions for the table of credit rates.
Hospital means a facility providing emergency or urgent care, inpatient medical care and nursing care for acute illness,
injury surgery or obstetrics and includes a facility licensed by the Department of Health as a critical access hospital, general
hospital, long-term acute care hospital, psychiatric hospital, rehabilitation hospital, limited services hospital and special
hospital.
New Mexico CRS Identification Number
Name of business
Enter the report period as shown on the attached CRS-1 return
Name and phone number of contact
through
MM/DD/YY
MM/DD/YY
HOW TO COMPLETE THIS FORM: Complete all information requested in the business name block above. The reported
tax period must match the tax period shown on the CRS-1 return. Compute the credit amount on the worksheet below
and attach to the New Mexico CRS-1 Long Form. Submit the CRS-1 Long Form and Form RPD-41324, Gross Receipts
Tax Credit for Certain Hospitals Claim Form, on or before the due date of the return. Do not reduce the tax liability shown
on the CRS-1 Long Form by the credit claimed. Underpay the liability due on the report by the amount of the cedit to be
applied. Mail to New Mexico Taxation and Revenue Department, P. O. Box 25128, Santa Fe, New Mexico 87504-25128.
For assistance call (505) 476-3683 or your local district office.
Column 1: Enter the location of the hospital (municipality and/or unincorporated area of a county).
Column 2: Enter the amount from Column F of your CRS-1 report for the current report period.
Column 3: Enter the percentage rate, from the charts in the instructions, of the credit applicable to this report period.
Column 4: Multiply the amount reported in Column 2 by the percentage rate in Column 3 and enter the product in Column 4.
Add all amounts in Column 4 and enter the sum in the TOTAL block. This is the credit available.
3. Enter the percentage
1. Municipality / County
4. Multiply Column 2
2. Enter the Taxable
applicable for the report
Name
by percentage rate
Gross Receipts
period of this claim
in Column 3
(Column F)
and the location of
the hospital
(see instructions)
TOTAL
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

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