Form Rpd-41271 - New Mexico Declaration Of Residency

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RPD-41271
STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
Rev. 02/2010
DECLARATION OF RESIDENCY
Film Production Company: Please complete highlighted line and retain the completed form for your records.
New Mexico Resident: Please complete the box below, sign, and date.
Purpose of this form: To assist film production companies in determining New Mexico residency.
Residency: To be a resident of New Mexico for tax purposes, 1) you must be domiciled in New Mexico, which
means New Mexico is your permanent home; 2) you must file or intend to file a New Mexico tax return as a
Resident or First-Year Resident; and 3) you must be domiciled in New Mexico on the last day of the taxable
year, December 31.
*Important Notes: If it is discovered that the applicant filed a New Mexico Non-Resident or Part-Year Resident
tax return or if the Taxation & Revenue Department has other evidence indicating the applicant is not a resident
(even though the applicant completed this form and provided evidence), the applicant will not qualify for the film
production tax credit. It should also be noted that the applicant is completing and signing this form under penalty
of perjury.
Name (please print)
Social Security Number
Permanent Residence - physical address (P.O. boxes not accepted)
Telephone Number
City, State and ZIP Code
Position
Film Project Title
1. Are you a New Mexico resident? See Residency above.
YES
NO
2. You must provide evidence (select one below) to show proof of residency - and be able to physically show
the production proof. Please check the applicable box and attach proof to this form.
A copy of last year’s New Mexico personal income tax return (filing as a
or
Resident
First-Year Resident)
A valid New Mexico’s driver’s license. Enter driver’s license number:
Voter registration card. Enter the registering county:
Other. Indicate Type:
Other evidence must be clear and
convincing and show intent to maintain a permanent residence in New Mexico. Proof of ownership of
property or establishing an abode in New Mexico is not acceptable unless supplemented by other
information showing intent.
3. What type of New Mexico tax return do you file or intend to file?
Resident
First-Year Resident
Part-Year Resident
Non-Resident
4. Do you understand that you are signing this form under penalty of perjury?
YES
NO
I declare under penalty of perjury that I have completed this document to the best of my knowledge and verify
that it is true, correct and complete. By signing this form, I authorize
(film production company name) to act as my representative for disclosure
of my residency status administered by the New Mexico Taxation & Revenue Department.
New Mexico Resident’s Signature
Date

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