Annual Statement of Pass Through Entity Withholding
Annual Statement of Pass Through Entity Withholding
New Mexico state tax withheld
New Mexico state tax withheld
New Mexico Taxation and Revenue Department
New Mexico Taxation and Revenue Department
Owner s federal identification number Check one: FEIN SSN
Owner s federal identification number Check one: FEIN SSN New Mexico Net Income of the owner from the pass through entity
Owner s name street address city state ZIP code Check if address is outside the U S
Owner s name street address city state ZIP code Check if address is outside the U S New Mexico Net Income of the owner from the pass through entity
Owners 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
Owners 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
Pass through entity s name street address city state ZIP code and telephone number Check if address is outside the U S Pass through entity s CRS identification number
Pass through entity s name street address city state ZIP code and telephone number Check if address is outside the U S Pass through entity s CRS identification number
Rev 2/3/2012
Rev 2/3/2012
RPD 41359
RPD 41359
Tax Year Pass through entity s federal identification number (FEIN)
Tax Year Pass through entity s federal identification number (FEIN)
