ACD-31094
05/30/2019 
                    State of New Mexico - Taxation and Revenue Department

                    Form ACD-31094 FORMAL PROTEST

To file a formal protest, please enter all required information below. You may submit this form by email, 
Protest.Office@state.nm.us, fax, (505) 827-2487, or by mail, Taxation and Revenue Department, P.O. 
Box 1671 Santa Fe, NM 87504-1671. For questions, call (505) 827-9806.

Name of Taxpayer                                                                                 SSN# or NM ID #

Mailing Address                                                                                  Tax Program

City                                                                               State         Zip Code

Contact Name                                                     Telephone Number  Email Address

Dear Secretary:
I hereby file a formal protest with the Taxation and Revenue Department pursuant to Section 7-1-24 NMSA 
1978, against:

  Assessment for Tax Reporting Period Ending                                           Letter ID                                     
□
  Amount of Assessment Disputing                                               Assessment Date                         

□ Denial of Claim for Refund for Period Ending                                           Letter ID 
  Amount of Claim of Refund                                                                          Denial Date

□ Other (please specify) 

The facts relating to this protest are as follows: 

The grounds for this protest are:                               

I request the following affirmative relief:  

I will provide the following evidence to support each ground asserted in this protest:                               

I declare that the information reported on this form and any attached supplements are true and correct.

Signature of taxpayer or agent                                                           Title                         Date

Type or print name                                                 Phone                 Email Address