Form Crs-1 - Reporting Gross Receipts, Withholding And Compensating Taxes - 2013 Page 19

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State of New Mexico - Taxation and Revenue Department
CRS-1 -
LONG FORM
PAGE 1
COMBINED REPORT SYSTEM
Mail to: NM Taxation and Revenue Department,
P.O. Box 25128, Santa Fe, NM 87504-5128
NEW MEXICO
NAME
CRS ID NO.
STREET / BOX
CITY, STATE, ZIP
Check if applicable:  Amended report
T A X
P E R I O D
Payment made by:
through
 Automated clearinghouse deposit
Date ________________
Month
Day
Year
Month
Day
Year
 Federal wire transfer
Date ________________
If additional space is needed, use the supplemental page.
Do not submit a photocopy of these forms to the Department. If additional space is needed, please obtain an original form
from your local district office or download the form from our web site at
A
Municipality / county
Location
Gross receipts
Total
Taxable gross
Tax
Gross
Special
B
C
D
E
F
G
H
name
code
(excluding tax)
deductions
rate
receipts tax
code*
receipts
Enter total of columns D, E and H, this page.
* See instructions for column B.
$
$
$
If supplemental pages are attached, enter total
of all columns D, E and H from this page
$
$
$
and all supplemental pages.
I declare that I have examined this return including any accompany-
TOTAL GROSS RECEIPTS
ing schedules and statements, and to the best of my knowledge and
TAX ALL PAGES
1
belief, it is true, correct and complete.
2
COMPENSATING TAX
WITHHOLDING TAX
3
Signature of taxpayer or agent
TOTAL TAX DUE
4
Print name
Date
PENALTY
5
Title
Phone
6
INTEREST
TOTAL AMOUNT DUE
7
E-mail address
19

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