Form Rpd-41239 - Application For Technology Jobs Tax Credit
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2STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
RPD - 41239
Rev. 12/12/2011
APPLICATION FOR TECHNOLOGY JOBS TAX CREDIT
Mail this form to: Taxation and Revenue Department, ATTN: Director's Office, P.O. Box 8485, Albuquerque, New Mexico, 87198-8485.
For the status of the credit application call: (505) 841-6478.
A taxpayer conducting qualified research at a qualified facility and making qualified expenditures is eligible to claim the basic technology
jobs tax credit. Additional credit is available for a taxpayer who increases annual payroll expense by $75,000 over base payroll for every
$1,000,000 in qualified expenditures claimed by the taxpayer in a taxable year in the same claim.
PLEASE PRINT OR TYPE
New Mexico CRS Identification Number
Name of Business
Street Address
City, State and ZIP Code
City, State and ZIP Code
Mailing Address
Name of Contact Person
Telephone Number
Fax Number
For the year January 1, _______ to December 31, _______
(See reverse side for instructions)
1.
Qualified Research (please define type of research) _____________________________________________________
______________________________________________________________________________________________
2.
Qualified Facility (Indicate type of facility and physical location) ____________________________________________
______________________________________________________________________________________________
3.
Qualified Expenditures (Attach expense summary and description of qualified expenditures)
___________________
4.
Basic Technology Jobs Tax Credit .........................................................................................
___________________
4% of Qualified Expenditures or 8% if in a rural area
5.
Additional Technology Jobs Tax Credit ..................................................................................
___________________
4% of Qualified Expenditures or 8% if in a rural area
(Attach Payroll Expense Summary. It must reflect base payroll.)
6.
Total Technology Jobs Tax Credit...........................................................................................
___________________
Add lines 4 & 5
I declare I have examined this application, including accompanying schedules and
statements, and to the best of my knowledge and belief it is true, correct and complete.
____________________________________________
_________________________
Taxpayer Authorized Signature
Date
NEW MEXICO TECHNOLOGY JOBS TAX CREDIT
Authorized by the New Mexico Taxation and Revenue Department
Claim No. __________________
Approved by: _______________________________________
Title: _______________________________________
Telephone number: __________________________________
Date: _______________________________________
Base credit amount approved: _________________________
Additional Credit Approved:______________________
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