Form Rpd-41326 - New Mexico Rural Health Care Practitioner Tax Credit Claim Form Page 2
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3State of New Mexico - Taxation & Revenue Department
RPD-41326
Rev. 08/27/2014
RURAL HEALTH CARE PRACTITIONER TAX CREDIT CLAIM FORM
Schedule A
Once a credit application is approved by NMDOH, complete and attach Form RPD-41320, Rural Health Care PractitionerTax
Credit Claim Form, including Schedule A, to your New Mexico income tax return along with the applicable tax credit Schedule
CR for the tax program you are applying the credit towards. Attach a copy of your certificate from NMDOH.
(a)
(b)
(c)
(d)
(e)
(f)
Certification number
Date of approval
Amount of credit
Total credit claimed
Unused credit [(c) - (d)]
Applied to the attached
approved
in previous tax years
return
TOTAL credit available
Enter the sum of column (f) here and on
line 3 of Form RPD-41326, page 1.
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