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

                      T A X    P E R I O D                           Check if applicable:   Amended report 
                        through                                      Payment made by: 
                                                                      Automated clearinghouse deposit               Date ________________
Month     Day  Year                      Month     Day Year
                                                                      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 www.tax.newmexico.gov.

Municipality / county Special          Location    Gross receipts      Total          Taxable gross   Tax                           Gross 
A       name          B code* C          code    D (excluding tax) E deductions     F  receipts     G rate                     H    receipts tax

  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

E-mail address                                                         7       TOTAL AMOUNT DUE

State of New Mexico - Taxation and Revenue Department 

CRS-1 -     LONG FORM Supplemental
COMBINED REPORT SYSTEM 
Rev. 09/2010
 
 Page ____ of _____

 NAME                                                                     NEW MEXICO
                                                                             CRS ID NO.

                       T A X    P E R I O D
                         through
 Month Day  Year                          Month Day Year

Use this page if additional space is needed to report gross receipts from multiple locations. 
Attach this page to Page 1 of the CRS-1 Long Form. 
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 www.tax.newmexico.gov.

 Municipality / county Special   Location       Gross receipts    Total        Taxable gross     Tax    Gross 
A      name            B code* C        code D  (excluding tax) E deductions F receipts        G rate H receipts tax

       Total columns D, E and H this page.
       * See instructions for column B.         $               $                                     $