Form Rpd-41248 - Application To Be A Qualified Employer (Page 2 of 2) in pdf

Application to be a Qualified Employer

RPD-41248 (2013)

Rev. 4/29/2013

Page 2 of 2

I FURTHER CERTIFY THAT the manufacturing plant identified above meets at least one of the following conditions:

Check the box that applies and complete all information within the block marked.

(1) The manufacturing plant had no payroll in New Mexico during calendar year 2012.

(2) The manufacturing plant had a payroll in New Mexico for part of 2012, but less than the entire calendar

year of 2012, and the January 2013 monthly payroll includes payments to New Mexico residents employed at the site

exceeds the highest monthly payroll for such residents in 2012.

Provide the following information:

a. Time period(s) during 2012 when the manufacturing plant

had payroll in New Mexico.

b. Payroll payments to New Mexico residents in January 2013.

The highest monthly payroll payments to New Mexico residents in 2012.

(3) The manufacturing plant had a payroll in New Mexico for the entire calendar year of 2012, and the January

2013 payroll payments to New Mexico residents exceed by at least 10% both the payroll for all employees in January

2001, and the payroll for New Mexico residents for January 2012.

Provide the following information:

a. Payroll payments to New Mexico residents in January 2012.

b. Payroll payments to all employees in January 2001.

c. Payroll payments to New Mexico residents in January 2012.

(4) The manufacturing plant had a payroll in New Mexico for the entire calendar year of 2012 but had no payroll

in New Mexico in calendar year 2000, and the January 2013 payroll payments to New Mexico residents exceed by at

least 10% the payroll for New Mexico residents in January 2012.

Provide the following information:

a. Payroll payments in New Mexico for all employees in 2012.

b. Payroll payments to New Mexico residents in January 2013.

c. Payroll payments to New Mexico residents in January 2012.

NOTE: The New Mexico Taxation and Revenue Department is not precluded from performing other procedures to ensure

that the information provided on this form is correct and accurate in every way.

“Manufacturing” defined. “Manufacturing” means combining or processing components or materials to increase their value

for sale in the ordinary course of business. The definition explicitly excludes construction, farming, the processing of natural

resources and hydrocarbons, and certain power generation facilities.

Monthly Payroll” defined. “Monthly payroll” means the payroll payments paid to employees during a calendar month.

“

See FYI 360 for a discussion of the cash and accrual methods for determining monthly payroll.

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

Title

Date

Form Rpd-41248 - Application To Be A Qualified Employer Page 2