New Mexico State Taxation and Revenue Department

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					                              State Of New Mexico – Taxation and Revenue Department
                                           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:


CITY, STATE, ZIP:                                                          TELEPHONE NUMBER:

FILM PROJECT TITLE:                                                        POSITION:


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 the 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 Resident or 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?

       First-Year Resident
       Part-Year 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 NM
Taxation & Revenue Department.

___________________________________________________________________________________        __________________________________
New Mexico Resident’s Signature                                                            Date

Description: New Mexico State Taxation and Revenue Department document sample