Angel Investment Tax Credit Application Form

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New Mexico Economic Development Department
Return all requests and attachments to:
ANGEL INVESTMENT TAX CREDIT
Angel Investment Tax Credit Program
NM Economic Development Dept.
APPLICATION FORM
1100 St. Francis Drive
Joseph M. Montoya Building, Ste. 1060
Santa Fe, NM 87504
To be completed by the small business who
Questions regarding the program can be directed to
is recipient of the qualified cash investment
antoinette.vigil@state.nm.us
– (505) 827-0264
in equity eligible for the angel investment
juan.torres@state.nm.us
– (505) 827-0238
tax credit.
See Program Guidelines for additional information
Including definitions and procedures
Section A: Qualifying the small business
Name of the small
business/recipient
NAICS Code
FEIN
NM CRS Id No.
Mailing address
City, state, zip
Contact name
Contact phone
Contact E-mail
Indicate the type of ownership:
‡ Corporation
‡ General partnership
‡ Subchapter S Corporation
‡ Limited partnership
‡ LLC or similar organization
‡ Estate
‡ Trust
‡ Other. Please indicate
Is the small business registered with the New Mexico Secretary of State or the New Mexico Public
Regulation Commission’s, Corporations Bureau?
Yes
No
‡
‡
Date of incorporation or organization
Date business began in New Mexico
Has the small business operated under any other name since Jan 2007?
Yes
No
‡
‡
(If yes, indicate the name. EDD may request additional information.)
Page 1
New Mexico Economic Development Department
Int. 7/24/2012

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