Form Rpd-41288 - Application For High Wage Jobs Tax Credit
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5STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
RPD-41288
Rev 09/10/2013
APPLICATION FOR HIGH WAGE JOBS TAX CREDIT
based job created on or after July 1, 2004 and before July 1, 2020, that is occupied during a qualified period beginning with the
Who Must File: An eligible employer may file this form to apply for a high wage jobs tax credit for each new high wage economic
year the new job is created and for three consecutive qualifying periods. The amount of the credit is 10% of wages and employer's
benefits paid or distributed to an eligible employee in a high wage economic based job for a maximum credit of $12,000 per quali-
fied period. (See the instructions for important definitions.) For status of the application, call (505) 841-6478.
New Mexico CRS identification number
Name of eligible employer
Physical address
City, state and ZIP code
Mailing address
City, state and ZIP code
Name of contact
Phone number
E-mail address
1. Enter the total number of eligible employees occupying a qualifying high-
Total high wage jobs tax credit.
wage job in a qualified period, included in this application. Refer to the
number of employees reported in the Employee Eligibility Detail Report.
2. Enter the total high wage jobs tax credit claimed:
$
from column AC of the Employee Eligibility Detail Report)
(
NOTE: A CD containing the High wage Jobs Tax Credit -Employee Eligibility Detail Report and all supporting documentation (payroll registers,
employer's paid benefits, sales documentation for the last 12 months, proof of newly created jobs for individuals being claimed, and proof of
increase of high wage jobs for the qualifying period) must be attached to this application. The Employee Eligibility Detail Report may be down-
loaded from our website at
Under penalty of perjury I declare that I have examined this claim, and to the best of my knowledge and belief it is true,
correct and complete.
Signature of claimant
Date
day of , 20
Subscribed and sworn before me this
Notary Public
My commission expires
Authorized by the New Mexico Taxation and Revenue Department.
FOR DEPARTMENT USE ONLY
Approved by:
Title:
Telephone number:
Date:
$
High wage jobs tax credit amount approved:
Claim number:
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