Form Rpd-41249 - Notice Of Approval Of A Qualified Employer printable pdf download

Form Rpd-41249 - Notice Of Approval Of A Qualified Employer

State of New Mexico – Taxation and Revenue Department

RPD-41249 (2013)

Rev. 4/29/2013

Notice of Approval of a Qualified Employer

for Allocation of Non-resident Employee Income

from Manufacturing Plants in New Mexico Within 20 Miles of

International Border (Section 7-2-11 NMSA 1978)

Calendar Year 2013 –

page 1 of 2

Purpose: The business listed below is approved as a qualified employer for calendar year 2013. This form serves as notice

to the employee of the approval and it must be retained in the employee’s records. For each year that a business qualifies,

employees who are not residents of New Mexico may choose to allocate or apportion income earned at the qualified manu-

facturing plant to their state of residence. Only income earned by a non-resident of New Mexico at an approved business

location may qualify for these special allocation and apportionment procedures. All other New Mexico source income must

be allocated to New Mexico.

A copy of this approved form is to be given to non-resident employees at qualifying New Mexico plant locations by a qualified

employer. Department approval must be obtained prior to delivery to the non-resident employee.

This section is to be completed by the New Mexico Taxation and Revenue Department.

Name of Qualified Employer

Physical Address of the Qualified Manufacturing Plant

City/ State/ ZIP

New Mexico Taxation and Revenue Department Use Only

The business described herein has been approved by the Taxation and Revenue Department as a Qualified Employer

for calendar year 2013 for purposes of Section 7-2-11 NMSA 1978.

Signature of Department Employee

Title

Date

This section is to be completed by the non-resident employee.

Name of Non-resident Employee (please print your name)

I swear under penalty of perjury that I am a non-resident employee of a New Mexico qualified employer em-

ployed at the above plant location. I further declare that I have examined this document, including accom-

panying statements, and to the best of my knowledge and belief it is true, correct and complete.

Signature of Non-resident Employee

Date

Form Rpd-41249 - Notice Of Approval Of A Qualified Employer