Form Crs-1 - Combined Report System (Long Form) - State Of New Mexico Taxation And Revenue Department

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State of New Mexico - Taxation and Revenue Department
CRS-1 -
LONG FORM
PAGE 1
COMBINED REPORT SYSTEM
Rev. 09/2010
Mail to: NM Taxation and Revenue Department,
P.O. Box 25128, Santa Fe, NM 87504-5128
NEW MEXICO
NAME
CRS ID NO.
STREET / BOX
CITY, STATE, ZIP
Check if applicable:  Amended report
T A X
P E R I O D
Payment made by:
through
 Automated clearinghouse deposit
Date ________________
Year
Month
Day
Year
Month
Day
 Federal wire transfer
Date ________________
If additional space is needed, use the supplemental page.
Do not submit a photocopy of these forms to the Department. If additional space is needed, please obtain an original form
from your local district office or download the form from our web site at
Municipality / county
Location
Gross receipts
Total
Tax
Gross
Special
Taxable gross
A
B
C
D
E
F
G
H
name
code
(excluding tax)
deductions
rate
receipts tax
code*
receipts
Enter total of columns D, E and H, this page.
$
$
$
* See instructions for column B.
If supplemental pages are attached, enter total
of all columns D, E and H from this page
$
$
$
and all supplemental pages.
I declare that I have examined this return including any accompany-
TOTAL GROSS RECEIPTS
ing schedules and statements, and to the best of my knowledge and
1
TAX ALL PAGES
belief, it is true, correct and complete.
2
COMPENSATING TAX
3
WITHHOLDING TAX
Signature of taxpayer or agent
4
TOTAL TAX DUE
Print name
Date
5
PENALTY
Title
Phone
6
INTEREST
TOTAL AMOUNT DUE
7
E-mail address

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