Get Cg2014 2016-2024

Rev. 08/25/2015 PIT-CG NEW MEXICO CAREGIVER S STATEMENT The caregiver must complete this PIT-CG and give it to the taxpayer to attach to the PIT-1 Return and Schedule PIT-RC. Each caregiver who provides daycare services for which a credit amount is claimed completes a separate PIT-CG. Failure to attach the required PIT-CG to the PIT-1 will cause the amount claimed for the child daycare credit to be disallowed. Attach the Child Day Care Credit Worksheet to the PIT-CG. each child for whom the credit is claimed. The caregiver must answer the three qualification questions enter their name address phone number and New Mexico CRS identification number and sign this PIT-CG. The name and social security number for each child receiving daycare services is required on this PIT-CG. The taxpayer must also sign. Do not include any charges for childcare for periods of unemployment or for childcare provided either before or after work plus any necessary travel time or for periods the taxpayer is attending school. Taxpayer s first name and initial as it appears on Form PIT-1 Taxpayer s social security number Taxpayer s last name PART I. TAXPAYER IF YOU COULD NOT OBTAIN A STATEMENT FROM THE CAREGIVER COMPLETE THIS PART OF THE FORM. If you made all reasonable attempts to complete this PIT-CG schedule and you are still unable to locate the caregiver or to obtain the required information complete Parts I and II of this schedule based on previous billings or other records provide the name and address of the caregiver and explain below why the caregiver did not complete the statement. QUALIFICATIONS FOR INDIVIDUAL CAREGIVERS Caregiver s name Caregiver s New Mexico CRS ID or SSN 1. Were you as a caregiver age 18 or over at the time the care was performed YES NO 2. Did you as a caregiver provide daycare service for less than 24 hours daily 3. Were you a dependent of the above taxpayer for whom you provided childcare services PART II. STATEMENT OF COMPENSATION RECEIVED BY CAREGIVER TAX YEAR CHILD 1 Name and SSN 20 Month No* of Days Compensation Amount Received Per Month JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL PART III. QUALIFICATIONS FOR INDIVIDUAL CAREGIVERS Caregiver s name Caregiver s New Mexico CRS ID or SSN 1. Were you as a caregiver age 18 or over at the time the care was performed YES NO 2. Did you as a caregiver provide daycare service for less than 24 hours daily 3. Were you a dependent of the above taxpayer for whom you provided childcare services PART II. Did you as a caregiver provide daycare service for less than 24 hours daily 3. Were you a dependent of the above taxpayer for whom you provided childcare services PART II. STATEMENT OF COMPENSATION RECEIVED BY CAREGIVER TAX YEAR CHILD 1 Name and SSN 20 Month No* of Days Compensation Amount Received Per Month JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL PART III. QUALIFICATIONS FOR INDIVIDUAL CAREGIVERS Caregiver s name Caregiver s New Mexico CRS ID or SSN 1. Were you as a caregiver age 18 or over at the time the care was performed YES NO 2. Did you as a caregiver provide daycare service for less than 24 hours daily 3. Were you a dependent of the above taxpayer for whom you provided childcare services PART II. STATEMENT OF COMPENSATION RECEIVED BY CAREGIVER TAX YEAR CHILD 1 Name and SSN 20 Month No* of Days Compensation Amount Received Per Month JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL PART III.