Form Rpd-41367 - Annual Withholding Of Net Income From A Pass-Through Entity Detail Report - 2012 Page 3

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

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