Form Rpd-41096 - Application For Extension Of Time To File

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STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
RPD-41096
Rev. 11/29/2011
APPLICATION FOR EXTENSION OF TIME TO FILE
PLEASE TYPE OR PRINT
INSTRUCTIONS ON REVERSE SIDE
Name of individual, firm or organization
Mailing address
City
State
ZIP code
New Mexico ID number
Social security number
Federal ID number
NOTE: If a federal automatic extension has been obtained for the period of this extension,
you do not need to submit Form RPD-41096, Application for Extension of Time to File.
To qualify for an extension, this form must be submitted on or before the due date of the return or the extended due date of the return.
An extension of time to file a return and pay the New Mexico tax liability is hereby requested, until _______________________.
NOTE: By obtaining an extension of time to file your return, penalty for failure to file and pay is waived through the extension period, pro-
vided you file the return and pay the tax shown on the return by the extended due date. Interest accrues even if the taxpayer obtains an
extension of time to file and pay the return. Interest is assessed daily at the quarterly rate established for individuals by the U.S. Internal
Revenue Code on the amount of tax due. Annual and daily interest rates for each quarter are posted on the Department web site.
Complete all three statements about the tax return that you wish to request an extension of time to file.
(Submit a separate extension request for each return. Do not combine multiple returns or multiple report periods on one application.)
1. The extension refers to the following New Mexico tax return (check one):
 Personal Income Tax Return
 Pass-Through Entity Return
 CRS-1, Combined Report of Gross Receipts, Compensating and Withholding Tax
 Fiduciary Income Tax Return
 Corporate Income and Franchise Tax Return
 Other
 S Corporate Income and Franchise Tax Return
2. For _______________________(year), or other taxable period beginning ___________________ and ending _________________.
3. State in detail the reason the extension is needed.
I declare that the information stated above is true and correct in every material matter.
Printed Name
Date
Authorized Signature
Title
DEPARTMENT USE ONLY
Under the Provisions of Section 7-1-13 NMSA 1978, your application for extension of time to file your tax return and pay the tax shown to be due
thereon has been reviewed. NOTE: Interest accrues even if an extension is granted.
Your application has been:
Authorized by:
 Approved
 Disapproved
 Approved with correction
Revenue Processing Division Bureau Chief
Extended for _________________days
Date of determination: ____________________________
Explanation of correction:
_________________________________________________
Initials of first reviewer ______
_________________________________________________
Extension number: _______________________________
_________________________________________________
Taxation and Revenue Department, P.O. Box 630, Santa Fe, New Mexico 87504-0630

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