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Form Rpd-41367 - Annual Withholding Of Net Income From A Pass-Through Entity Detail Report - 2014 Page 2

RPD-41367 (2014)

New Mexico Taxation and Revenue Department

*149090200*

Rev. 10/15/2014

2014 Annual Withholding of Net Income

From a Pass-Through Entity Detail Report

Supplemental Form

PTE’s FEIN

Pass-through entity’s name

Page ______ of _______

Col. 5

Owner’s name,

Column 2

Column 3

Column 4

RPD-41353

Owner’s SSN

Owner’s share of

street address,

on file

or FEIN

allocable net income

withholding tax

city, state, and ZIP code

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

YES

Mark one:

FEIN

SSN

Mark if outside the U.S.

If you need more space, print this supplemental form directly

from the website and attach the additional supplemental forms

Line 2. Total withholding

to the first page of this form. Reproducing from a photocopy

on this page.

reduces the readability of the barcode on scanning equipment.

PTW-D

Form Rpd-41367 - Annual Withholding Of Net Income From A Pass-Through Entity Detail Report - 2014 Page 2

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