Form RPD-41072 Fillable Annual Summary of Withholding Tax for CRS-1 Filers
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(: 1) Unchecked (: 2) Unchecked (: 3) Unchecked (5 May) (6 June) (7 July) (8 August) (all columns) (AMOUNT 1 January) (AMOUNT 10 October) (AMOUNT 11 November) (AMOUNT 2 February) (AMOUNT 3 March) (AMOUNT 3 March) (AMOUNT 9 September) (CITY STATE ZIP) (Date) (text) (text) (Title) (TOTAL (all columns)) (undefined) (undefined) 1 Enter the number of annual statements of withholding submitted (Federal Forms W 2 W 2G or 1099R) 1 January 10 October 11 November 12 December 2 February 2 Total New Mexico income tax withheld for the taxable year as shown on Federal Forms 3 March 3 Total New Mexico income tax withheld and reported on Form CRS 1 during the reporting year 4 April 4 Difference Subtract line 3 from line 2 (See "Other Attachments" in instructions) 41072 Annual Summary of Withholding Tax for CRS 1 Filers to reconcile the total amounts shown as withheld on annual 5 May 6 June 7 July 8 August 9 September ANNUAL SUMMARY OF WITHHOLDING TAX FOR CRS 1 FILERS be submitted to TRD Retain Form RPD 41072 in your records Mail the form to New Mexico Taxation and Revenue Depart CITY STATE ZIP Complete the information about your company and the reporting year (e g 2012) CRS 1 FILING FREQUENCY (Check one) CRS 1 tax was due Enter the sum of all "AMOUNT" columns in the box marked "TOTAL" Department you do not need to submit this form or submit Federal Forms W 2 W 2G or 1099R forms to TRD electronic or magnetic media (see Publication FYI 330 Information Returns and Magnetic Media Filing) you do not need Enter the New Mexico income tax withheld and reported to the Taxation and Revenue Department on Forms CRS 1 for each ES903 to the New Mexico Workforce Solutions Department or New Mexico Form TRD 31109 to the Taxation and Revenue Federal Forms W 2 W 2G and 1099R Attach a copy of all Federal Forms W 2 W 2G and 1099R to this report that Form RPD 41071 Application for Refund and amended CRS 1 returns for the period(s) in which overpayments occurred Form RPD 41072 should be completed on or before the last day of February of the year following the calendar year in which have not been provided to TRD by another means If you have or will be submitting the information returns to TRD through held by pass through entities required to withhold from a non resident owner's share of net income Remitters of oil and gas I declare that I have examined this return and accompanying documents and to the best of my knowledge and belief they are true correct and complete If You Discover a Discrepancy If you have underreported withholding on your CRS 1 returns you must submit amended returns for the period(s) in which Instructions Line 1 Enter the number of annual statements of withholding submitted (Federal Forms W 2 W 2G or 1099R) Line 2 Enter the total New Mexico income tax withheld for the taxable year as shown on Federal Forms W 2 W 2G or 1099R Line 3 Enter the total New Mexico income tax withheld and reported on Form CRS 1 during the reporting year Line 4 Subtract line 3 from line 2 and enter the difference ment P O Box 25128 Santa Fe NM 87504 5128 For assistance call (505) 476 3683 Mexico income tax from salaries or wages from pension or annuity income or from gambling winnings may use Form RPD month during the reporting year The reporting month is the month in which the taxes were withheld and not the month the MONTH MONTH MONTHAMOUNTAMOUNT AMOUNT Monthly N M CRS ID NUMBER REPORTING YEAR No refund will be paid on the basis of this report alone or New Mexico Form TRD 31109 to the New Mexico Taxation and Revenue Department (TRD) this form is not required to Other Attachments PART I Business Information PART II Schedule of New Mexico Income Tax Withheld and Reported on Form CRS 1 PART II Schedule of New Mexico Income Tax Withheld and Reported on Form CRS 1 (See instructions ) PART III Qualifying Information PART III Qualifying Information (See instructions ) PART IV Taxpayer Declaration PLEASE TYPE OR PRINT proceeds should refer to Form RPD 41283 Annual Summary of Oil and Gas Proceeds Withholding Tax Quarterly Reconcile the New Mexico income tax withheld and reported on Form CRS 1 to the New Mexico income tax withheld and reported on Federal Forms W 2 W 2G and 1099R Semiannually Sign and date the form If applicable prepare attachments and submit it to the Taxation and Revenue Department Signature: Title: Date: State of New Mexico Taxation and Revenue Department statement of withholding information returns furnished to withholdees (Federal Forms W 2 W 2G or 1099R) with the total STREET / BOX tax withheld and paid to New Mexico on CRS 1 returns Do not include tax withheld from oil and gas proceeds or tax with the tax was withheld If you file a wage and contribution report ES903 to the New Mexico Workforce Solutions Department to submit this form or submit Federal Forms W 2 W 2G or 1099R forms to TRD If you file a wage and contribution report TOTAL underreporting occurred and remit the difference If you have overpaid withholding on your CRS 1 returns you must submit W 2 W 2G or 1099R Who Must Complete This Form: Employers payers and gambling establishment operators who withhold a portion of New