RPD-41247                   State of New Mexico  - Taxation & Revenue Department
Rev. 10/23/2014
                    CERTIFICATE OF ELIGIBILITY FOR THE RURAL JOB TAX CREDIT

Purpose of Form.        Form RPD-41247 is to be used by a qualified employer to supplement a claim for the Rural Job Tax 
Credit. This form certifies the wages of an eligible employee during a qualified period for a qualified job. See the instructions 
for important definitions. 
How to File this Form. To apply for the Rural Job Tax Credit, complete Form RPD-41238                                                Application for Rural Job Tax 
Credit. Attach Form RPD-41247, Certificate of Eligibility for the Rural Job Tax Credit,                                for each qualified job in the eligible 
period claimed. Summarize the total eligible jobs and the wages on Form RPD-41238, Application for Rural Job Tax Credit. 
Submit all documentation to the Taxation and Revenue Department for approval. Once the credit is approved, you will 
receive notification from the Department. See the instructions for Form RPD-41238, Application for Rural Job Tax Credit,                                                                                                                                         
for further details.

For the status of the credit application, call (505) 383-0184 or (505) 383-0171.
  Name of eligible employer                                                                         New Mexico CRS identification number

 Physical address                                                                           City, state and ZIP code

 Mailing address                                                                            City, state and ZIP code

 Name of contact                                                              Phone number                                          Email address
                                                                                                                                     
1.  The date the qualifying job was created:

2.  Name of eligible employee(s) : 

3.  The qualifying period for this certificate is:                                  through
                                                                                (mm/dd/ccyy)                           (mm/dd/ccyy) 
4.  The number of qualified periods previously claimed for this qualifying job:
I certify that:   (Mark the boxes that apply and complete the required information.)
                       See the instructions for important definitions.
5.         the person(s) employed in this qualified period is an eligible employee as defined in 7-2E-1.1 NMSA 1978

6.         the job is a qualifying job as defined in 7-2E-1.1 NMSA 1978. 

7.         wages paid to the eligible employee during this qualified period were:  $ 

8.         number of weeks during the qualifying period that the position was occupied :

9.         the qualifying job is located in a:            tier one            tier two area.  

 Under penalty of perjury I declare that I have examined this claim, and to the best of my knowledge and belief it is 
 true, correct and complete.   

 Signature of claimant                                                                             Date 

 Subscribed and sworn before me this                                                        day of                                               , 20

 Notary Public                                                                              My commission expires 

RPD-41247                      State of New Mexico  - Taxation & Revenue Department
Rev. 10/23/2014
     INSTRUCTIONS FOR CERTIFICATE OF ELIGIBILITY FOR THE RURAL JOB TAX CREDIT
                                                                                                                     Page 1 of 2
ABOUT THIS CREDIT                                                 Definition of Eligible Employee  
Eligible employers may earn the rural job tax credit for each  Eligible Employee means any individual other than     an indi-
qualifying job created after July 1, 2000. The holder of the  vidual who:
credit may apply all or a portion of the rural job tax credit             a.  bears any of the relationships described in Para-
to gross receipts (excluding tax imposed by a municipality  graphs (1) through (8) of the 26 U.S.C. Section 152(a) to the 
or county), compensating, and withholding taxes due.  The  employer or, if the employer is a corporation, to an individual 
holder also may apply the credit to personal or corporate  who owns, directly or indirectly, more than 50% in value of the 
income taxes due.  See Form-41238,      Application for Rural     outstanding stock of the corporation or, if the employer is an 
Job Tax Credit, for further details.                              entity other than a corporation, to any individual who owns, 
                                                                  directly or indirectly, more than 50% of the capital and profits 
HOW TO COMPLETE THIS FORM                                         interest in the entity;
Complete all information requested in the address block.  An              b.  if the employer is an estate or trust, is a grantor, 
“eligible employer” is an employer in a tier one or tier two area  beneficiary or fiduciary of the estate or trust or is an individual 
(see below) who is eligibile for in-plant training assistance by  who bears any of the relationships described in Paragraphs 
the Economic Development Department pursuant to Section  (1) through (8) of the 26 U.S.C. Section 152(a) to a grantor, 
21-19-7 NMSA 1978.                                                beneficiary or fiduciary of the estate or trust, or
                                                                          c. is a dependent, as that term is described in 26 
1.  Enter the date the qualifying job was created. The qualify-   U.S.C. Section 152(a)(9), of the employer or, if the taxpayer 
ing job must have been created after July 1, 2000.                is a corporation, of an individual who owns, directly or indi-
2.  Enter the name of the eligible employee(s) occupying the  rectly, more than 50% in value of the outstanding stock of 
qualifying job. If more than one employee occupied the job dur-   the corporation or, if the employer is an entity other than a 
ing the qualified period, include the names of each employee.     corporation, of any individual who owns, directly or indirectly, 
3.  Enter the qualifying period for which this credit is claimed.  more than 50% of the capital and profits interests in the entity 
See the definition of “Qualifying Period” below.                  or, if the employer is an estate or trust, of a grantor, beneficiary 
4.   Enter the number of previous qualified periods claimed for  or fiduciary of the estate or trust.
this job.  The rural job tax credit may be claimed a maximum of:
     a. Four qualifying periods for each job performed or         Definition of Qualifying Job
based at a location in a tier one area.                           A job established by an eligible employer that is occupied 
     b. Two qualifying periods for each job performed or  by an eligible employee for at least 48  weeks of a qualifying 
based at a location in a tier two area.                           period. 

Certifications                                                    A qualifying job shall not be eligible for a rural job tax credit 
To qualify, all of the following certifications must be met. Check  pursuant to this section if:
the applicable boxes on the form that apply.                      1. The job is created due to a business merger, acquisition 
Refer to the definitions for the terms provided in these in-         or other change in organization;
structions.                                                       2. The eligible employee was terminated from employment 
                                                                     in New Mexico by another employer involved in the 
5.  Certify that the employee(s) who is occupying the job            merger, acquisition or other change in organization; and
during this period meets the definition of eligible employee.     3. The job is performed by:
6.   Certify that the job is a qualifying job as defined.            a.   The person who performed the job or its functional 
7.    Certify the wages paid to the eligible employee(s) occupy-          equivalent prior to the business merger, acquisition 
ing the qualifying job for the qualified period. Enter the lower          or other change in organization; or
of either the total wages paid to the employee or $16,000.           b.   A person replacing the person who performed the 
The maximum that may be claimed is $16,000 per qualifying                 job or its functional equivalent prior to the business 
job, per qualifying period.                                               merger, acquisition or other change in organization.
8.    Certify that an eligible employee has occupied this job for 
at least 48 weeks of the qualifying period indicated on line 3.   If, however, a qualifying job that was created by another 
9.    Certify whether the job is performed or based at a location employer and for which the rural job tax credit claim was 
in a tier one or a tier two area.                                 received by the Taxation and Revenue Department prior to 
                                                                  July 1, 2013, and is under review or has been approved shall 
Attach this form to Form RPD-41238, Application for Rural Job     remain eligible for the rural job tax credit for the balance of 
Tax Credit, and mail to: Taxation and Revenue Department,         the qualifying periods for which the job qualifies by the new 
ATTN:  Director’s Office, P.O. Box 8485, Albuquerque, NM          employer that results from a business merger, acquisition or 
87198-8485.                                                       other change in the organization.

RPD-41247               State of New Mexico  - Taxation & Revenue Department
Rev. 10/23/2014

INSTRUCTIONS FOR CERTIFICATE OF ELIGIBILITY FOR THE RURAL JOB TAX CREDIT
                                                                                                           Page 2 of 2
A job shall not be eligible for a rural job tax credit pursuant Definition of Qualifying Period
to this section if the job is created due to an eligible em-    “Qualifing Period” means the 12 months starting on the first 
ployer entering into a contract or becoming a subcontractor  day of an eligible employee’s working in a qualifying job, or 
to a contract with a governmental entity that replaces one or  12 months starting on the anniversary of the day the eligible 
more entities performing functionally equivalent services for  employee begins working in a qualifying job.
the governmental entity in New Mexico unless the job is a 
qualifying job that was not being performed by an employee      Definition of Tier Areas
of the replaced entity.                                         This credit is not available for jobs performed or based in 
                                                                Los Alamos County, the cities of Albuquerque, Los Ranchos, 
Definition of Wages                                             Corrales,  Rio  Rancho, Tijeras,  Santa  Fe,  Las  Cruces  or 
Effective July 1, 2013, wages means all compensation paid       Farmington, or within 10 road miles of any of these cities. Tier 
by an eligible employer to an eligible employee through the  two areas are Roswell, Clovis, Carlsbad, Hobbs, Gallup and 
employer’s payroll system, including those wages the em-        Alamogordo. Tier one area is anywhere within New Mexico 
ployee elects to defer or redirect, such as the employee’s      not listed above. 
contribution to 401(k) or cafeteria plan programs, but not 
including benefits or the employer’s share of payroll taxes.