New Mexico Angel Investment Credit Claim Form

Angel Investment Credit Claim Form
Form RPD-41320
New Mexico Taxation and Revenue Department

TRD-41404a
Rev. 07/01/2023

ANGEL INVESTMENT CREDIT
Application for Qualified Business

Who must file this form: This application is for a business which is seeking a credit for a qualified investment made on
or after January 1, 2019 through December 31, 2025. This application must be filled out by the Qualified Business, the Accredited Investor should fill out the TRD-41404b, refer to page 4 of this document, see instructions for more information.
Note: You can apply for the Angel Investment Credit online using our website, please see instructions for more information.
Section I: Application type
Qualified Business
BUSINESS/RECIPIENT NAME

FEIN/SSN

NAICS CODE

CONTACT E-MAIL

MAILING ADDRESS (NUMBER AND STREET)

STATE, CITY, ZIP

CONTACT NAME

CONTACT PHONE

NMBTIN

Section II: Qualified Business (Complete all applicable fields, see instructions.)
Section A: Qualifying the business
1.	 Indicate the type of ownership:
Corporation

Estate

General Partnership

LLC or Similar Organization

Limited Partnership

Subchapter

Trust

Other:

2.	 Is the business registered with the New Mexico Secre- 3.	 Date of incorporation or organization:
tary of State or the New Mexico Public Regulation Commission's Corporations Bureau?
Month
Day
Year
Yes
No
4.	 Date business began in New Mexico:
Month

Day

5.	 Has the small business operated under any other
name since January 2007?

Year

Yes

No

If yes, provide the name:

6.	 Specify the calendar year you are requesting approval
for:

7.	 What is the Investment Round for the Calendar Year in question 6 and how much do you plan on raising?

8.	 Do you anticipate rounds of Angel Investment this calendar year?
Yes

No

If yes, how many?

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TRD-41404a
Rev. 07/01/2023

New Mexico Taxation and Revenue Department

ANGEL INVESTMENT CREDIT
Application for Qualified Business

Yes

Answer the following questions about the small business:

No

9.	 Is the small business primarily engaged in or organized as any of the following types of businesses:
Credit or finance services, including banks, savings and loan association, credit unions, small loan
companies or title loan companies; financial brokering or investment; professional services, including accounting, legal services, engineering and any other service the practice of which requires a
license; insurance; real estate; construction or construction contracting; consulting or brokering;
mining; wholesale or retail trade; providing utility services, including water, sewerage, electricity,
natural gas, propane or butane: publishing, including publishing newspapers or other periodicals;
broadcasting; or providing internet operating services?
10.	 Has the small business issued securities registered pursuant to Section 6 of the federal Securities Act of 1933, as amended?
11.	 Has the small business issued securities traded on a national securities traded on a national
securities exchange?
12.	 Is the small business subject to reporting requirements of the federal Investment Company Act of
1940, as amended, at the time of the investment?
13.	 Does the small business have 100 or fewer employees calculated on a full-time equivalent basis
at the time of the investment?
14.	 Does the small business have gross revenues in excess of five million dollars in any fiscal year
ending on or before the date of the investment?
15.	 Describe the principle business activity

16.	 Enter the physical address where the qualifying principal activity described in 15 is performed. If the qualifying
business activity is performed in more than one location, enter all locations. If more space is needed, include an attached statement.
Physical Address

Physical Address

City

City

State

Zip Code

State

County

Zip Code

County

17.	 Does the small business perform other non-qualifying business activities?

Yes

No

If yes, describe the other non-qualifying business activities and indicate the address(es) where those activities are
performed. If additional space is needed, attach a statement

18.	 If the principal business activity that qualifies the small business is performed at a location where other business
activities are performed, indicate the address and the percent of the qualifying business activity performed at that
location to the total business activities performed at that location. If additional space is needed, attach a statement.

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TRD-41404a
Rev. 07/01/2023

New Mexico Taxation and Revenue Department

ANGEL INVESTMENT CREDIT
Application for Qualified Business

19.	 What is the percent of the qualifying business activity performed everywhere to the total business activities performed
everywhere?
Percentage:
Describe how the percent of business activity performed, in question 18 and 19 was computed (Example: based on
total revenues, number of employees working at the location, square foot of the facility, and etc.)?

20.	 List all owners/partners/officers/members of the small business and the percent of ownership. Attach additional
pages if needed.
First Name

Last Name

Percent Ownership

21.	 How many jobs have been created by the business to date?
22.	 How many part-time employees do you employ?
23.	 How many full-time employees do you employ?
24.	 What is the annual average wage of your employees?
Section B: About the qualifying cash investment received
25.	 Complete the following for each qualifying cash investment in equity made by an accredited investor. Use an attachment for more than one qualifying cash investment received with this application.
a.	 Amount of cash investment made?
b.	 Date the cash investment was received?
c.	 Name of the accredited investor
d.	 Contact name and phone number of the accredited investor?
e.	 What was received by the accredited investor in exchange for the cash investment? If stock, describe the type of
stock (for example common of preferred) including any option, how many shares were received, and the official
name of the business under which the stock is listed. If you received an interest in the business, please describe.

26.	 Has the accredited investor or a member of the immediate family or an entity affiliated with the accredited investor
received or will receive compensation from the business in exchange for services provided to the qualified business
within one year of the investment in the qualified business? If yes, please explain.

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TRD-41404a
Rev. 07/01/2023

New Mexico Taxation and Revenue Department

ANGEL INVESTMENT CREDIT
Application for Qualified Business

Section III: Program Effectiveness (Complete all applicable fields, see instructions.)
27.	 How important a factor was the Angel Investment program in the company’s decision to develop the technology, idea, process or application in New Mexico?

28.	 How important was the received qualified investment
to the success of your company?
Very Important

Very Important

Important

Important

Not Important

Not Important

30.	 How effective is the Angel Investment Tax Credit?

29.	 Have you received any non-dilutive funding (grants,
foundation funds, etc)?
Yes
No
If yes, how much?

31.	 What can we do to improve the program?

32.	 Please share comments regarding your experience
with the Angel Investment program:

Signature required to evaluate for credit
Under penalty of perjury, I declare I have examined this application, including accompanying attachments. To the best of
my knowledge and belief this application is true, correct and complete.

Print Name

Signature

Title

4

Date

New Mexico Taxation and Revenue Department

TRD-41404b
Rev. 07/01/2023

ANGEL INVESTMENT CREDIT
Application for Accredited Investor

Who must file this form: This application is for a taxpayer who is seeking a credit for a qualified investment made on or
after January 1, 2019 through December 31, 2025. This application must be filled out by the Accredited Investor, the Qualified Business should fill out the TRD-41404a, refer to page 1 of this document, see instructions for more information.
Note: You can apply for the Angel Investment Credit online using our website, please see instructions for more information.
Section I: Application type
Accredited Investor
ACCREDITED INVESTOR NAME

FEIN/SSN

NMBTIN

MAILING ADDRESS (NUMBER AND STREET)

STATE, CITY, ZIP:

CONTACT NAME

CONTACT PHONE
CONTACT E-MAIL

Section II: Accredited Investor (Complete all applicable fields, see instructions.)
Section A: Qualifying the investor
1.	 If the cash investment was made from a trust, IRA or an entity with a federal identification number that is different
from the individual completing this form, the name of the accredited investor should reflect the ownership information of the trust, IRA or other entity below. If yes, indicate the type of ownership below. If not, go to step 28
Name of entity:

Contact Name (if different):

FEIN:

Contact Phone:

Percent Ownership:

Contact E-mail:

Mailing Address:

City, State, Zip:

Indicate the type of ownership:
Corporation

Estate

General Partnership

LLC or Similar Organization

Limited Partnership

Subchapter

Trust

Other:

2.	 Is the investor an accredited investor as defined under the Securities Act of 1933, Rule 501 of Regulation D?
Yes

No

If yes, under which definition of accredited investor (documentation is required)?
Income of $200,000 or more per year
Income of yourself and spouse is $300,000 or more per year
Net worth of greater than $1 million, excluding home
A trust of $5 million or more
Other (Please describe)

(Attachments required, see instructions.)

Section B: About the qualifying cash investment made
3.	 What is the amount of the cash investment?

4.	 What was the date of the cash investment?
Month

Day

Year

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New Mexico Taxation and Revenue Department

TRD-41404b
Rev. 07/01/2023

ANGEL INVESTMENT CREDIT
Application for Accredited Investor

5.	 If the cash investment was made to a middle party for the sake of investment purpose, such as into a trust, LLC, or
an entity with a federal identification number that is different from the individual completing this form, and the entity
subsequently made an investment into a qualified company, the name and type of the entity should be stated below.
If so, indicate the type of ownership below (The entity will have to fill out a separate Angel Investment Credit Application). If not, go to 6.
Name of entity:

Contact Name (if different):

FEIN:

Contact Phone:

Percent Ownership:

Contact E-mail:

Mailing Address:

City, State, Zip:

Indicate the type of ownership:
Corporation

Estate

General Partnership

LLC or Similar Organization

Limited Partnership

Subchapter

Trust

Other:

6.	 Provide the below information about the qualified business to whom the investment was made:
Business Name

NMBTIN

Contact Name

Contact Phone Number

7.	 Describe what was received in exchange for the cash investment? If stock, describe the type of stock (for example
common or preferred) including any options, warrants, how many shares were received, and the official name of the
business under which the stock is listed. If you received an interest in the business, please describe. If you received
units of an LLC or partnership, please state the number of units and percent ownership following the investment.

8.	 Have you or a member of your immediate family or an entity affiliated with the accredited investor received or will
receive compensation from the business in exchange for services provided to the qualified business within one year
of the investment in the qualified business? If yes, please explain

Signature required to evaluate for credit
Under penalty of perjury, I declare I have examined this application, including accompanying attachments. To the best of
my knowledge and belief this application is true, correct and complete.

Print Name

Signature

Title

6

Date

New Mexico Taxation and Revenue Department

TRD-41404
Rev. 07/01/2023

ANGEL INVESTMENT CREDIT
Instructions

New Legislation:

Phone: 1-505-795-1735
E-mail: [email protected].

Effective May 20, 2020 under new legislation the review
and approval of the Angel Investment Credit has been
transferred from the Economic Development Department to
the Taxation and Revenue Department.

Once the completed forms and attachments have been
reviewed and processed and the Taxation and Revenue
Department determines the taxpayer to be an accredited
investor and the investment to be a qualified investment, a
dated Certificate of Eligibility will be mailed to the address
provided.

Purpose of this Application:

Form TRD-41404a, Angel Investment Credit Application for
Qualified Business and the TRD-41404b, Angel Investment
Credit Application for Accredited Investor has been created
to replace the Angel Investment Applications previously
used by the Economic Development Department. This form
needs to be filled out by the Qualified Business or the Accredited Investor.

Note: Please see the Attachments Needed for the Angel
Investment Credit table on the next page and provide applicable attachments to avoid delays in processing your application.

This application is to be used by a taxpayer who files a New
Mexico income tax return, is not a dependent of another
taxpayer, is an accredited investor and makes a qualified investment. The taxpayer may apply for, and the department
may allow, a claim for a credit in an amount not to exceed
twenty-five percent (25%) of the qualified investment; provided that a credit for each qualified investment shall not
exceed sixty-two thousand five hundred dollars ($62,500).
Accredited investors may claim the angel investment credit
for not more than one qualified investment per investment
round. A taxpayer may claim the angel investment credit for
qualified investments for no more than five qualified businesses per tax year. Any unused angel investment credits
may be carried forward for five consecutive years.

Apply for the Angel Investment Credit Online:

A taxpayer may apply for an angel investment credit by submitting a completed application to the Taxation and Revenue Department using the TRD-41404a or TRD-41404b
no later than one year following the end of the calendar year
in which the qualified investment is made. Complete all sections specified based on application type selected in Section I. A complete application is required. Should you need
assistance completing this application, please contact the
Taxation and Revenue Department:

Accredited Investors must fill out TRD-41404b, Angel Investment Credit Application for Accredited Investor. Please
see the table at the bottom of page 8 for a list of required
documentation.

You can submit your Angel Investment Credit Application
online using the Department's website, Taxpayer Access
Point (TAP) https://tap.state.nm.us. From the TAP homepage, select account type (PIT or FID), click on Apply for Tax
Credit, and follow the steps to complete the Angel Investment Credit Application. NOTE: You must have a TAP account to apply for the credit online.

Completing the Application:

Qualified Business must fill out TRD-41404a, Angel Investment Credit Application for Qualified Business. Please
see the table at the bottom of page 7 for a list of required
documentation.

NOTE: To ensure that the application is processed timely,
be sure to fill out all applicable fields and provide all required
documents Both application types require a signature.

Attachments Needed for a Completed Angel Investment Credit Application
Qualified Business Documentation:
Proof of Gross Revenues less than •	
$5 million in any fiscal year ending on •	
or before the date of the investment

Copy of return(s) if a New Mexico return was not filed
Provide year to date income statement if a return has not been filed for the
investment year

Majority of tangible assets in NM

Supporting documentation to show the majority of tangible assets are in New
Mexico

•	

Engages in research and develop- •	
ment or engages in manufacturing

Supporting documentation may be requested if unable to verify internally

Additional documentation may be requested if unable to verify internally.

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New Mexico Taxation and Revenue Department

TRD-41404
Rev. 07/01/2023

ANGEL INVESTMENT CREDIT
Instructions

Submitting the Application:

You can also contact the Economic Development Department by phone or by e-mail at:

You can fill out and submit this application online see Apply
for the Angel Investment Credit Online.

Phone: 1-505-827-0300
Email: [email protected].

You can also submit the completed application by mail:
NM Taxation and Revenue Department
Attn: Business Tax Credits
PO Box 8485
Albuquerque, New Mexico 87198

To Claim the Credit:

The taxpayer must attach to the personal income tax return
(Form PIT-1) or fiduciary income tax return (Form FID-1) a
completed Schedule CR (PIT-CR or FID-CR), RPD-41320,
Angel Investment Credit Claim Form, and a copy of the
Certificate of Eligibility issued by the Taxation and Revenue
Department certifying the Angel Investment Credit and approving the taxpayer for the credit.

The Department will make a determination within 120 days
of the date on which the completed application is received.
You may call (505) 795-1735 or send an email to check the
status. If approved, the applicant will be issued a document
granting the tax credit.

NOTE: Failure to submit the required forms and documents
outlined above will result in a denial of the credit. For assistance with claiming the credit see the instructions on the
RPD-41320, Angel Investment Claim Form.

Important: A copy of the application and supporting documents must to be submitted to the Economic Development
Department.

Definitions:
Accredited investor- means a person who is an accredited
investor within the meaning of Rule 501 issued by the federal securities and exchange commission pursuant to the
federal Securities Act of 1933, as amended.

NM Economic Development Department
Attn: Angel Investment Tax Credit Program
P.O. Box 20003
Santa Fe, NM 87504

Documentation Required for Completed Application
Accredited Investor Documentation:
Proof of $1 million net worth
(excluding home)

•	
•	
•	
•	

Net worth statement
Account balance statements
Tax return showing net worth
Other supporting documentation may be reviewed

Proof of income ($200,000 or more •	
for an individual or, $300,000 if
married)
•	

Proof of income for the year of the investment and the two years prior to the
investment
Other supporting documents may be reviewed

Proof of $5 million trust

•	
•	

Letter from bank verifying trust information and account balance
Other supporting documents may be reviewed

Other

•	

Supporting documentation to show accredited investor as defined under the Securities Act of 1933, Rule 501 of Regulation D

Proof of Investment

•	

Copy of the check, bank statement showing the transaction or proof of the wire
transfer
If a third party is involved proof of investment from accredited investor to third
party is needed, along with proof from third party to Qualified Business.
Other supporting documentation may be reviewed

•	
•	
Verification of equity received in
exchange for the cash investment

•	

Supporting documentation to show qualified investment in a qualified business
for equity

Qualified Business Approval

•	

Approval letter from NM Taxation and Revenue sent to the qualified business.

Additional documentation may be requested if unable to verify internally.

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TRD-41404
Rev. 07/01/2023

New Mexico Taxation and Revenue Department

ANGEL INVESTMENT CREDIT
Instructions

Qualified business- means a business that:
(a) maintains its principal place of business and employs
a majority of its full-time employees, if any, in New Mexico
and a majority of its tangible assets, if any, are located in
New Mexico;
(b) engages in qualified research or manufacturing activities
in New Mexico;
(c) is not primarily engaged in or is not primarily organized
as any of the following types of businesses: credit or finance
services, including banks, savings and loan associations,
credit unions, small loan companies or title loan companies;
financial brokering or investment; professional services,
including accounting, legal services, engineering and any
other service the practice of which requires a license; insurance; real estate; construction or construction contracting;
consulting or brokering; mining; wholesale or retail trade;
providing utility service, including water, sewerage, electricity, natural gas, propane or butane; publishing, including
publishing newspapers or other periodicals; broadcasting;
or providing internet operating services;
(d) has not issued securities registered pursuant to Section
6 of the federal Securities Act of 1933, as amended; has not
issued securities traded on a national securities exchange;
is not subject to reporting requirements of the federal Securities Exchange Act of 1934, as amended; and is not registered pursuant to the federal Investment Company Act of
1940, as amended, at the time of the investment;
(e) has one hundred or fewer employees calculated on a
full-time-equivalent basis in the taxable year in which the
investment was made; and
(f) has not had gross revenues in excess of five million dollars ($5,000,000) in any fiscal year ending on or before the
date of the investment.

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