State of New Mexico - Taxation & Revenue Department
RPD-41246
INT. 12/2001
INCOME TAX CREDIT FOR
ELECTRONIC IDENTIFICATION CARD READER
PURCHASE AND USE STATEMENT
Purpose of Form.
Name of Business Eligible for the Credit
Address of Contact
Phone Number
Name of Contact
CRS Identification No.
Liquor Licence No.
Location(s) of Eligible Business.
Physical address of business location using electronic identification card reader(s).
1.
Physical address of business location using electronic identification card reader(s).
2.
Physical address of business location using electronic identification card reader(s).
3.
Physical address of business location using electronic identification card reader(s).
4.
Claimant Information.
Name and address
Claimant Statement.