Form Rpd 41295 – Fill Out and Use This PDF

	RPD-41295	New Mexico Taxation and Revenue Department
	Rev. 03/2005
		Application for New Mexico Retail Food Store Certification
		for the food deduction pursuant to Section 7-9-92 NMSA 1978

PART 1 - Business Information

Retail store information: Complete one application for each store location.

Street address

City, state and zip code

Contact name, phone number and e-mail address

Location of records; physical address

CHECK if applicable: The retail food store described in this application is requesting eligibility for New Mexico retail store certification retroactive to January 1, 2005. The description of this retail store operation contained within this application has been in effect since on or before January 1, 2005.

If you are authorized to accept food stamps under the federal Food Stamp Act, you do not need to file this application and obtain the New Mexico Retail Food Store Certificate to qualify to take the food deduction pursuant to Section 7-9-92 NMSA 1978. Maintain your Food Stamp Program authorization in your files.

NOTE: All information submitted on this application is subject to verification by physical inspection.

PART 2 - Retail Store Operation Information

1. Type of business (Check one)

Supermarket
(Annual gross sales $2 million or more)		Nonprofit food buying co-op			Other route
Medium or small grocery		Wholesaler			Grocery/gas station
Convenience store		Military commissary			Grocery/bar
Produce stand (single store application)		Other food store			Grocery/restaurant
Multi-stall farmers’ market (application for multiple stalls)		Milk route			General store
Specialty foods - meat store, fish store, bakery, etc....		Bread route			Other combination
Health/natural food store		Produce route

2. Inventory and services sold (Check all that apply)

Check the inventory and services at this store from choices listed below:

Gasoline

Lottery Tickets

Clothing

Tobacco Products

Motor Oil

Beer/Wine

Outdoor Equipment

Other Services. What are they? (Games,

Household supplies

Liquor

Hardware

videos, pharmacy, etc....) List below. Add

Hot Food

Auto Parts

Food Stamp Issuance

page if needed. ___________________

_________________________________

3. Staple foods in inventory stock (Check all that apply)

Check the staple foods in inventory at this store from the choices listed below:

Bread, baked goods, rice, pasta, cereal, chips,

Eggs

Canned/frozen/packaged staple foods

cookies, crackers, etc.)

Dairy Products (milk, cheese, butter, yogurt, etc.)

(including 100% juices)

Produce (fruits, vegetables)

Fish/Seafood

Meat (beef, pork, lamb, etc.)

Poultry/Fowl (chicken, turkey, etc)

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	RPD-41295	New Mexico Taxation and Revenue Department
	Rev. 03/2005
		Application for New Mexico Retail Food Store Certification
		for the food deduction pursuant to Section 7-9-92 NMSA 1978

PART 3 - STAPLE FOOD STOCK

Complete either Section A or B using the terms defined in the instructions.

Section A: Firms that carry a full line of groceries - Complete this part if your store stocks on a continuous basis an ample variety of the types of foods listed below in each category.

Check “Variety” for each staple food category you sell in your store which meets the definition of variety (see instructions). Also, check “Perishable” for each category which meets the definition of perishable (see the instructions).

Staple Food Category Examples of staple food items		Variety			Perishable
Bread/Cereals	Bread, cereals, pasta, grains, rice, flour
Dairy Products	Cheese, butter, milk, yogurt
Fruits/Vegetables	All forms of fruits, vegetables, 100% juice
	(Include fresh, frozen and canned)
Meat/Poultry/Fish	Beef, chicken, bacon, ham, shellfish, sandwich meats
	(Include fresh, frozen and canned)

Section B: Firms with a specialty line of Staple Foods - Check the box below if your business sells a limited variety or line of staple foods; for example, a bakery, milk route, produce stand or meat market. Stores selling only accessory foods do not qualify. See Qualifying as a “retail food store” in the instructions. Provide the annual retail food sales and the annual gross sales at this location that you reported for the same time period for Gross Sales in Part 4 (see below) for the past two years. This may be an estimated figure.

Check if applicable:	I am applying for New Mexico Retail Food Store Certification under Section B.
PART 4 - SALES INFORMATION
Gross sales reporting method: (Circle one)		Actual	Estimated*

*Use estimated ONLY if previous year information is not yet available, or if this is a new store. You may be required to submit actual figures when available.

I declare that I have examined this application, including any accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.

Signature of Taxpayer or Agent		Date
Print name	Title	Phone

FOR DEPARTMENT USE ONLY

This application for New Mexico Retail Food Store Certification was reviewed by the New Mexico Taxation and Revenue Department and was approved.

Name of Certified New Mexico retail food store

Authorized Department Signature

Date of approval

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RPD-41295	New Mexico Taxation and Revenue Department
Rev. 03/2005	Application for New Mexico Retail Food Store Certification
	for the food deduction pursuant to Section 7-9-92 NMSA 1978
	INSTRUCTIONS

Who Must File This Form Effective January 1, 2005, receipts of certain retail food stores from the sale of food intended for home consumption are deductible from gross receipts pursuant to Section 7-9-92 NMSA 1978. To qualify as a retail food store eligible to take the new deduction for sales of certain foods against gross receipts tax, the establishment either must file this application for New Mexico Retail Food Store Certification, or be currently authorized to accept food stamps under the federal Food Stamp Act. A taxpayer who can accept food stamps under the federal Food Stamp Act is a retail food store for purposes of Section 7-9-92 NMSA 1978 for tax periods during which the taxpayer is authorized to accept food stamps. Such a taxpayer does not require state certification to take the food deduction against gross receipts.

Complete this application and submit it to the department. When approved, you will receive a New Mexico Retail Food Store Certification and may begin taking the deduction for qualified sales of certain foods pursuant to Section 7-9-92 NMSA 1978. Mark the box in PART 1 if you are requesting certification retroactive to January 1, 2005.

Qualifying as a retail food store: To qualify, a retail store must meet at least one of two criteria the federal government sets. It either must stock and offer a variety of foods on a continuous basis in each of four staple food categories - two of which must be perishable foods - or function as a specialty store attributing 50% or more of its gross retail sales to staple foods. The terms food, retail food store, staple food and variety are defined in the federal Food Stamp Act of 1964. See these important definitions below. Stores selling only accessory foods including spices, candy, soft drinks, tea or coffee, ice cream, or dough- nuts or bakeries not selling bread are ineligible. These stores stores do not qualify to accept food stamps and therefore do not qualify as retail food stores for the gross receipts tax deducion in New Mexico.

IMPORTANT DEFINITIONS

Food Any food or food product intended for human consumption, except alcoholic beverages, tobacco, hot foods and hot food products prepared for immediate consumption. Food also includes seeds and plants to grow foods for personal con- sumption of households according to 7 USCA 2012(g)(1).

Retail Food Store An establishment that sells food for home preparation and consumption. For New Mexico purposes the establishment must meet the federal definition of retail food store in 7-USCA 2012(K)(1) for federal food stamp purposes whether or not it actually participates in the federal Food Stamp Program. Stores or markets where staple sales make up less than 50% of gross receipts, concessions, sidewalk or open-air vendors and vending machines do not qualify. Do not include coffee, tea, cocoa, carbonated and non-carbonated drinks, candy, condiments and spices in the 50%.

Variety Enough items (no fewer than 3) in each of the staple food groups listed below to meet most people’s food needs. Staple Food (1) Bread, rice, pasta, (2) dairy foods, (3) fruits and vegetables and (4) meats (fresh, packaged, canned or frozen). Do not count hot foods, prepared foods such as sandwiches or salads, candy, condiments, spices, coffee, tea, cocoa, or carbonated or non-carbonated drinks.

Perishable foods Fresh, frozen or refrigerated food that could spoil in two or three weeks.

Completing this form: File one application for each location. Complete all parts of this application and all information as requested, or your application may be returned without review. Be sure to transfer the business name and the CRS identifica- tion number from the first page to the top of the second page. Sign the application. Mail the completed application to the local district tax office nearest you. The phone numbers of the local district tax offices are also included in the listing below. If approved, your application will be returned to you with department approval.

ALBUQUERQUE: Taxation & Revenue Department		LAS CRUCES:
	P.O. Box 8485	Taxation & Revenue Department
	Albuquerque, NM 87198-8485	P.O. Box 607
	Telephone: 505/841-6200	Las Cruces, NM 88004-0607
		Telephone: 505/524-6225
SANTA FE:	Taxation & Revenue Department
	P.O. Box 5374	ROSWELL:
	Santa Fe, NM 87502-5374	Taxation & Revenue Department
	Telephone: 505/827-0951	P.O. Box 1557
		Roswell, NM 88202-1557
FARMINGTON: Taxation & Revenue Department		Telephone: 505/624-6065
	P.O. Box 479
	Farmington, NM 87499-0479
	Telephone: 505/325-5049

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