Form RPD-41359 Annual Statement of Pass-through Entity Withholding

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)