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
