Form Rpd-41071 - Application For Refund Page 2
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3RPD-41071
Request for Direct Deposit
Rev. 8/2/2012
If you are requesting a refund of tax, fees or surcharges paid to the New Mexico Taxation and Revenue Department for any of the
programs listed below and would like your refund deposited directly into your bank account, complete the following information. NOTE:
If the information below is incomplete or incorrect, your refund will be mailed. Your account cannot be located at a financial institution
outside the territorial jurisdiction of the United States. See the instructions.
Combined Report System Taxes (CRS), Personal Income Tax, Corporate Income and Franchise Tax, Oil and Gas Proceeds
Withholding Tax, Enhanced 911 Surcharge, Telecommunication Relay Service Surcharge, Water Conservation Fee, Weight
Distance Tax, and Workers' Compensation Fee.
Required:
Will this refund go to or
Routing number:
1.
through an account located outside
the territorial jurisdiction of the United
Account number:
States? If yes, you may not use this refund
2.
delivery option.
Type:
Checking
Savings
Yes
No
3.
4.
Required:
FOR DEPARTMENT USE ONLY
I have analyzed the records of the Taxation and Revenue Department on _______________________________ , 20 _______
and have verified the amount of tax overpayment. I hereby certify that a tax refund is due as claimed according to Section 7-1-26
NMSA 1978. The amount of overpayment is for the following taxes:
TAX PROGRAM
AMOUNT
1.
$
Claim number
2.
Serial number
3.
Warrant number
Total interest to be refunded
$
Total amount to be refunded
Analysis of reason for overpayment:
Valid overpayment:
o YES
o NO
o Need additional information
Credit amount $_______________
Amended returns on file:
o YES
o NO
o N / A
Credit key____________________
Date requested ______________________________________
Documents supporting this refund are on file:
GENERAL APPROVAL
I recommend refund:
Secretary or Delegate
Initiated by
IF REQUIRED
Section supervisor
Date
Attorney General's Office
Bureau chief
Date
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Parent category: Financial