Form Rpd-41365 - Notice Of Transfer Of Rural Job Tax Credit
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1State of New Mexico - Taxation and Revenue Department
RPD-41365
Int. 12/12/2011
Notice of Transfer of Rural Job Tax Credit
Purpose of this Form.
Form RPD-41365, Notice of Transfer of Rural Job Tax Credit, must be used to report to the New Mexico Taxation and Revenue
Department (TRD) a transfer or distribution of approved rural job tax credit to another taxpayer. This notice must be signed
by the holder or the authorized representative of the holder of an approved credit. Notice must be mailed to TRD within 10
days of a sale, exchange or other transfer. The current holder must have a TRD approved Form RPD-41238, Application for
Rural Job Tax Credit, before using this Form RPD-41365 to report a transfer.
Mail to New Mexico Taxation and Revenue Department, PIT Edit Error, P.O. Box 5418, Santa Fe, New Mexico 87502-5418.
For assistance completing this form, call (505) 476-3683.
Rural job tax credit sold, exchanged, transferred or distributed:
Credit number of holder:
Approval date of holder:
Date of the transfer:
Amount of rural job tax credit transferred:
Transferred from:
Name of holder
SSN or FEIN
Phone number
Name of contact (if applicable)
E-mail address
Under penalty of perjury, I certify that I have examined this form and attachments and to the best of my knowledge and
belief, it is true, correct and complete.
Signature of the holder authorizing
Date
the transfer of the credit.
Transferred to:
Name of new holder
SSN or FEIN
City, state and ZIP code
Mailing address
Under penalty of perjury, I certify that I have examined this form and attachments and to the best of my knowledge and
belief, it is true, correct and complete.
Signature of the holder to whom
Date
the credit is transferred.
TO BE COMPLETED BY THE NEW MEXICO TAXATION AND REVENUE DEPARTMENT
Date of approval of the credit:
Approved amount of rural job tax credit:
New credit number:
Rural job tax credit is approved as submitted.
Rural job tax credit is not approved. See the attached explanation.
Rural job tax credit is approved, but the amount of the credit has been adjusted. See the attached explanation.
Signature of Secretary or authorized delegate: __________________________________
Date: _____________________
Name (please print):_______________________________________
Title: ______________________________________
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