New Mexico Nonresident Recipient Of Oil And Gas Proceeds Income Tax Agreement printable pdf download

New Mexico Nonresident Recipient Of Oil And Gas Proceeds Income Tax Agreement

RPD-41286

State of New Mexico - Taxation and Revenue Department

INT. 10/2003

NEW MEXICO NONRESIDENT RECIPIENT OF OIL AND GAS PROCEEDS

INCOME TAX AGREEMENT

NONRESIDENT RECIPIENT (REMITTEE)

REMITTER'S (Payer) NAME AND MAILING ADDRESS

NAME AND MAILING ADDRESS

Name

Street or other mailing address

City, state and zip code

Federal identification number

Social security number or federal employer identification number

Effective period of agreement:

You must check one:

Current Year

Continuous

Through _____________

Enter first taxable year of agreement period election: Beginning ___________, ending ______________

This agreement is valid until revoked in writing by the nonresident owner.

Nonresident owners must submit this agreement to the remitter named above. Do not submit this agreement to the

Department. The agreement must be retained in the remitter’s records. The remitter may be required to furnish a true and

correct copy of this agreement upon the Department’s request.

Under penalty of perjury I agree to file New Mexico income tax returns and make timely payment

of all taxes imposed by the State of New Mexico with respect to my share of the New Mexico

oil and gas proceeds of the remitter (payer) named above. I also agree to be subject to the

jurisdiction of the State of New Mexico for purposes of the collection of unpaid income tax,

related penalties and interest.

Authorized signature _____________________________________________________

Date _______________

State of _________________ County of ___________________

Subscribed and sworn to before me by ___________________________ on this ________

day of ________________________, ___________.

__________________________________________ My commission expires:_____________

Notary Public

New Mexico Nonresident Recipient Of Oil And Gas Proceeds Income Tax Agreement