Form Pit-8453 - Individual Income Tax Declaration For Electronic Filing And Transmittal - 2014
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3State of New Mexico Taxation and Revenue Department
ACD-31012 (2014)
Rev. 11/10/2014
INDIVIDUAL INCOME TAX DECLARATION FOR
PIT-8453
ELECTRONIC FILING AND TRANSMITTAL
2014
For the year January 1 - December 31, 2014
Social security number
Your first name and middle initial
Last name
RESIDENCY
STATUS
Spouse's first name and middle initial
Social security number
Last name
RESIDENCY
STATUS
Your mailing address, city, state, and ZIP code
(3) Married filing separately (Enter spouse's social security number.)
FILING STATUS (Check one)
(4) Head of household (Enter name of person who qualifies you as head of household
(1) Single
if that person is not counted as a qualified exemption on your federal return.) _____________________
(2) Married filing jointly
(5) Qualifying widow(er)
PART I
TAX RETURN INFORMATION (WHOLE DOLLARS ONLY)
1.
Federal Adjusted Gross Income (PIT-1 return, line 9) ................................
1.
Net New Mexico Income Tax (PIT-1 return, line 22) ...................................
2.
2.
3.
3.
Total Payments and Credits (PIT-1 return, line 32).....................................
4.
4.
Tax Due (PIT-1 return, line 33) ...................................................................
5.
Overpayment (PIT-1 return, line 39) ...........................................................
5.
PART II
DECLARATION OF TAXPAYER
I declare the amounts described in Part I above agree with the amounts shown on the corresponding lines of my New Mexico personal
income tax return, and that I have examined the contents of my electronic return and accompanying schedules and statements. To the
best of my knowledge and belief, my return is true, correct, and complete. I consent that my return, including accompanying schedules
and statements, be electronically transmitted to the New Mexico Taxation and Revenue Department.
PLEASE
SIGN
HERE
Your signature
Date
Spouse's signature (If joint return, BOTH MUST sign.)
PART III
DECLARATION OF PREPARER/TRANSMITTER (if applicable)
PAID PREPARER'S, ELECTRONIC RETURN ORIGINATOR'S or OTHER THIRD-PARTY TRANSMITTER'S USE ONLY
I declare the above taxpayer's return is based on all pertinent information of which I have knowledge. I have verified that the taxpayer's
name shown on this declaration agrees with the name that appears on the proof of account. A copy of all forms and information to be
filed with or transmitted to the New Mexico Taxation and Revenue Department have been provided to the taxpayer.
Preparer's/Transmitter's signature
Date
CRS identification number
Check if self-employed
Firm's name (or yours, if self-employed)
ZIP code
Address (number, street, city, and state)
When required to submit a copy of this form to the Department, mail the form and attachments to:
New Mexico Taxation and Revenue Department, P.O. Box 5418, Santa Fe, NM 87502-5418
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