Form PTE Pass-Through Entity Income and Information Return

Interest from U S government obligations or federally taxed New Mexico bonds New Mexico allocated income (From PTE B column 2 line 9) New Mexico apportionable income (Multiply line 12 by line 13) New Mexico net income (Add lines 14 and 15) Original Return (other than taxpayer or an employee of the taxpayer) is based on all information of which preparer has any knowledge Signature of preparer if other than employee of the taxpayer Date *127080200* *127380200* 00 00 00 00 00 00 00 00 1 Property factor (Divide column 2 by column 1 and multiply by 100) 10 00 11 00 12 00 14 00 15 00 16 00 2 Payroll factor (Divide column 2 by column 1 and multiply by 100) 2012 PTE A New Mexico Apportionment Factors 2012 PTE B 2012 PTE New Mexico Information Return 4a The entity submitted written notification of its election to apportion business income utilizing the 5 AVERAGE PERCENT (Divide the factor on line 4 by the number of factors computed above; enter on PTE line 13) 8 Total allocated income (Add lines 1 through 7; enter on PTE line 11) 9 Total New Mexico allocated income (Add lines 1 through 7; enter on PTE line 15) A State in which organized B Date of organization / / Allocated income (From PTE B column 1 line 8) Allocated Non business Income Taxable to Owners Allowable deductions from Schedule K Amended Amount from lines 1 and 2 passed to owners on Form 1099 Misc or RPD 41359 Apportionable income (Add lines 9 10 and 11 then subtract from line 8) Average annual value of inventory Average annual value of real property Average annual value of personal property Rented property (Annual rental value times 8) Total Property Average New Mexico percentage (From PTE A line 5) C Date business began in New Mexico / / D Date terminated in New Mexico / / CHECK ONE: City state and ZIP code Column 1 Column 1 everywhere Column 2 within new mexiCo PerCent within new mexiCo Column 2 Date election was made (See instructions) for Pass Through Entities four factor method for the tax year ending Gross receipts I declare that I have examined this return including accompanying schedules and statements and Paid preparer's use only: Interest income from municipal bonds (Excluding New Mexico bonds) Mailing address Net non business dividends Net non business interest Net non business partnership income (loss) Net non business profit sale of assets (loss) Net non business rents (loss) Net non business royalties new mexiCo inCome Ordinary income (loss) from Federal Form 1065 Schedule K Other income (loss) from Federal Form 1065 Schedule K Other net non business income (loss) PAYROLL FACTOR PROPERTY FACTOR SALES FACTOR Sales factor (Divide column 2 by column 1 and multiply by 100) Section 1 Tax Withheld From the Pass through Entities (PTE) Income Section 2 Other Withholding Information Reporting Section 3 Computation of Net Income Taxable to Owners Subtotal of lines 5 through 7 Tax withheld and paid by the PTE on owner's net income (From Form RPD 41367) Tax withheld from oil and gas proceeds received (Attach 1099 Misc or Form RPD 41285) Tax withheld on PTE allocable net income (Attach 1099 Misc or Form RPD 41359) Taxpayer's name Title Contact phone number Signature of officer member or partner Date Taxpayer's E mail address Print preparer's name NM CRS Identification number FEIN PTIN Preparer's phone number to the best of my knowledge and belief it is true correct and complete Declaration of preparer Total compensation of employees TOTAL FACTORS (Add lines 1 2 and 3) total inCome everywhere