Form Rpd-41368 - Notice Of Distribution Of Technology Jobs Tax Credit

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State of New Mexico - Taxation and Revenue Department
RPD-41368
Int. 12/12/2011
Notice of Distribution of Technology Jobs Tax Credit
Page 1 of ____
Purpose of this Form.
Form RPD-41368, Notice of Distribution of Technology Jobs Tax Credit, must be used to report to the New Mexico Taxation
and Revenue Department (TRD) a distribution of approved technology jobs tax credit from a pass-through entity (PTE) to
owners, members or partners of the PTE. This notice must be signed by the authorized representative of a PTE that has
been approved for the technology jobs tax credit. Notice should be mailed to TRD within 10 days of the transfer. The PTE
must have a TRD approved Form RPD-41239, Application for Technology Jobs Tax Credit, before using this Form RPD-
41368 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.
Technology jobs tax credit transferred:
Credit number of PTE:
Approval date of PTE:
Date of the transfer:
Amount of technology jobs tax credit
transferred:
Transferred from:
Name of PTE
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 PTE
Date
authorized representative
Transferred to:
Name of owner, member or partner
Amount
SSN
FEIN
Name of owner, member or partner
SSN
Amount
FEIN
Name of owner, member or partner
Amount
SSN
FEIN
Amount
Name of owner, member or partner
SSN
FEIN
Name of owner, member or partner
SSN
Amount
FEIN
Name of owner, member or partner
SSN
Amount
FEIN
Amount
Name of owner, member or partner
SSN
FEIN

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