New Mexico Application for NM Retail Food Store Certification

Application for NM Retail Food Store Certification
Form RPD-41295
RPD-41295
Rev.05/13/2022

New Mexico Taxation and Revenue Department

Application for New Mexico Retail Food Store Certification
for the Food Deduction

Who Must File This Form: 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. Note: Each store location must submit a separate
RPD-41295. Important: If you are authorized to accept food stamps under the Federal Food Stamp Act, see instructions
before completing this form.
Part I: Business Information (Complete form in blue or black ink and use print in all fields)
Business Name

NMBTIN

Store Name (If different than above)

FEIN, SSN, or ITIN
NMBTIN

Chain Store Unit Number

FEIN

SSN, or ITIN

Street Address

City

State

Zip Code

Physical Address (Location of Record)

City

State

Zip Code

Contact Name

Phone Number

E-mail Address

Part II: Retail Store Operation Information
1. Type of business (Check one)
†	
†	
†	
†	
†	
†	
†	
†	
†	
†	
†	

Bread route
Convenient store
General Store
Grocery/bar
Grocery/gas station
Grocery/restaurant
Health/natural food store
Medium or small grocery store
Military commissary
Milk route
Multi-stall farmers' market (appli-

cation for multiple stalls)
†	 Nonprofit food buying co-op
†	 Produce route
†	 Produce stand (single store application)
†	 Specialty food- meat store,fish
store, bakery, etc.
†	 Supermarket (annual gross sales
>$2 million)
†	 Wholesaler
†	 Other combination

†	 Other food store
†	 Other route

†	
†	
†	
†	
†	
†	

†	 Tobacco Products
Other: Specify- ______________
___________________________

Other: Specify- ______________
___________________________
___________________________
___________________________
___________________________
___________________________

2. Type of business (Check one)
†	
†	
†	
†	
†	
†	

Auto Parts
Beer/Wine
Clothing
Food Stamp Issuance
Gasoline
Hardware

Hot Food
Household Supplies
Liquor
Lottery Tickets
Motor Oil
Outdoor Equipment

___________________________
___________________________

3. Staple foods in inventory stock (Check all that apply)
†	 Baked goods (bread, rice pasta,
cereal, chips, cookies, crackers,
etc.)
†	 Canned/frozen, packaged staple
foods (including 100% juices)
†	 Dairy Products (milk, cheese, butter, yogurt, etc.)

†	
†	
†	
†	

Eggs
Fish/Seafood
Meat (beef, pork, lamb. etc.)
Poultry/Fowl (chicken, turkey,
etc.)
†	 Produce (fruits and vegetables)

1

†	 Other: Specify- ______________
___________________________
___________________________
___________________________
___________________________

RPD-41295
Rev.05/13/2022

New Mexico Taxation and Revenue Department

Application for New Mexico Retail Food Store Certification
for the Food Deduction

RPD-41295 Continued. Both page 1 and 2 must be submitted or request may be denied.
Store name and chain unit number

NMBTIN

Part III: Staple Food Stock (Complete either A or B)
A. Carry full line of groceries (Check all that apply)
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

Example of staple food items

Variety

Perishable

Bread/Cereals

Bread, cereals, pasta, grains, rice, flour

o

o

Dairy Products

Cheese, butter, milk, yogurt

o

o

Fruits/Vegetables

fruits, vegetables, 100% juice (fresh/frozen/canned)

o

o

Meat/Poultry/Fish

Beef, chicken, bacon, ham, shellfish, sandwich meats (fresh/frozen/canned)

o

o

B. 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.

†	 Applying for New Mexico Retail Food Store Certification under Section B.
Part IV: Staple Food Stock (Continued form page 1)
1. Gross sales reporting method (Check one)

†	 Actual
†	 Estimated- use ONLY if previous year information is not yet available or if this is a new store.

2. Annual sale break down, *as reported to the IRS for the last two tax years at this location:

TY

Federal Tax Year

Annual Retail Food Sales*

Annual Gross Sales*

1.
2.
Part V: Signature (Required)
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.
Name (First and Last)

Title

Signature of above name taxpayer or agent

Date

Phone Number

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

2

RPD-41295
Rev.05/13/2022

New Mexico Taxation and Revenue Department

Application for New Mexico Retail Food Store Certification
for the Food Deduction
Instructions

Who is required to file RPD-41295
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. Additional information can be located in
FYI-201, Gross Receipts Tax and Certain Foods.

Completing This Form
Taxpayer must file one application for each location. Complete all parts of this application and all information as requested. An incomplete application may result in the denial
of your request. All information submitted on this application
is subject to verification by physical inspection.

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 Supplemental Nutrition Assistance Program (SNAP) under the federal Food Stamp Act of 1964.

Be sure to transfer the business name and the New Mexico
Business Tax Identification Number (NMBTIN) from the first
page to the top of the second page. Sign the application.
If 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.

A taxpayer who can accept SNAP under the federal Food
Stamp Act is a retail food store for purposes of Section 7-992 NMSA 1978 for tax periods during which the taxpayer
is authorized to accept SNAP. Such a taxpayer does not
require state certification to take the food deduction against
gross receipts.

Form Submission
You can mail or email your completed RPD-41295 form to
the Department:
Mail: NM Taxation and Revenue Department
Attn: Compliance Registration Unit
PO Box 8575
Albuquerque, NM 87198-8575

Qualifying As a Retail Food Store
To qualify, a retail store must meet at least one of two criteria the federal government sets forth in 7 USCA 2012(o)(1):
1.	 An establishment, house-to-house trade route, or online entity that sells food for home preparation and consumption and—
A.	 offers for sale, on a continuous basis, a variety of at
least 7 foods in each of the 4 categories of staple
foods specified in subsection (q)(1), including perishable foods in at least 3 of the categories; or
B.	 has over 50 percent of the total sales of the establishment or route in staple foods,

E-mail: [email protected]

Important Definitions
•	 Food- (1) Any food or food product intended for home
consumption, except alcoholic beverages, tobacco, hot
foods, and hot food products prepared for immediate
consumption other than those authorized by the federal
government. (2) Seeds and plants for use in gardens to
produce food for the personal consumption of the eligible household. Important: Refer to 7 USCA 2012(k)(1)
for a full list as set forth by the federal government.
•	

Staple Food- (1) Meat, poultry, or fish, (2) Bread or cereals, (C) Vegetables or fruits, or (D) Dairy Products.
Note: Staple foods does not include food items such
as coffee, tea, cocoa, carbonated and noncarbonated
drinks, candy, condiments, and spices.

•	

Perishable Foods- staple food that is fresh, refrigerated, or frozen.
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