Looking for a New Mexico Tax Forms And Templates? Download it for free!

Form Rpd-41249 12 - Notice Of Approval Of A Qualified Employer - State Of New Mexico Taxation And Revenue Department

State of New Mexico – Taxation and Revenue Department

RPD-41249 12

Rev. 09/25/2012

Notice of Approval of a Qualified Employer

for Allocation of Nonresident Employee Income

from Manufacturing Plants in New Mexico Within 20 Miles of

International Border (Section 7-2-11 NMSA 1978)

Calendar Year 2012 –

page 1 of 2

Purpose: The business listed below is approved as a qualified employer for calendar year 2012. This form serves as notice

to the employee of the approval and it must be retained in the employee’s records. For each year that a business qualifies,

employees who are not residents of New Mexico may choose to allocate or apportion income earned at the qualified manu-

facturing plant to their state of residence. Only income earned by a nonresident of New Mexico at an approved business

location may qualify for these special allocation and apportionment procedures. All other New Mexico source income must

be allocated to New Mexico.

A copy of this approved form is to be given to nonresident employees at qualifying New Mexico plant locations by a qualified

employer. Department approval must be obtained prior to delivery to the nonresident employee.

This section is to be completed by the New Mexico Taxation and Revenue Department.

Name of Qualified Employer

Physical Address of the Qualified Manufacturing Plant

City/ State/ ZIP

New Mexico Taxation and Revenue Department Use Only

The business described herein has been approved by the Taxation and Revenue Department as a Qualified Employer

for calendar year 2012 for purposes of Section 7-2-11 NMSA 1978.

Signature of Department Employee

Title

Date

This section is to be completed by the nonresident employee.

Name of Nonresident Employee (please print your name)

I swear under penalty of perjury that I am a nonresident employee of a New Mexico qualified employer employed

at the above plant location. I further declare that I have examined this document, including accompanying

statements, and to the best of my knowledge and belief it is true, correct and complete.

Signature of Nonresident Employee

Date

Form Rpd-41249 12 - Notice Of Approval Of A Qualified Employer - State Of New Mexico Taxation And Revenue Department