Form RPD-41285 Annual Statement of Withholding of Oil and Gas Proceeds

Annual Statement of Withholding of Oil and Gas Proceeds Annual Statement of Withholding of Oil and Gas Proceeds Check if foreign address New Mexico state tax withheld Check if foreign address New Mexico state tax withheld Check if foreign address Recipient s federal identification number Check one: FEIN SSN Check if foreign address Recipient s federal identification number Check one: FEIN SSN New Mexico Taxation and Revenue Department New Mexico Taxation and Revenue Department Payer s name street address city state ZIP code and telephone number Payer s CRS identification number Payer s name street address city state ZIP code and telephone number Payer s CRS identification number Recipient s name street address city state ZIP code Gross oil and gas proceeds Recipient s name street address city state ZIP code Gross oil and gas proceeds Recipients must attach this form to the New Mexico state income tax return to claim the amount of tax withheld against personal income or corporate income tax due Recipients must attach this form to the New Mexico state income tax return to claim the amount of tax withheld against personal income or corporate income tax due RPD 41285 Rev 10/2010 RPD 41285 Rev 10/2010 Taxable Year Payer s federal identification number Check one: FEIN SSN Taxable Year Payer s federal identification number Check one: FEIN SSN