Form Rpd-41374 - Annual Report Of Non-Resident Remittees Holding An Agreement To Pay Tax On Oil And Gas Proceeds - 2013 Page 2
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2RPD-41374 (2013)
New Mexico Taxation and Revenue Department
*134090200*
Rev. 5/3/2013
2013 Annual Report of Non-Resident
Remittees Holding an Agreement to Pay
Tax on Oil and Gas Proceeds
- Supplemental Page -
Remitter’s FEIN or SSN
Remitter’s name
Check one:
FEIN
Page _______ of _______
SSN
Remittee’s name,
Column 2
Column 3
Column 4
street address,
Remittee’s SSN/FEIN
Remittee’s oil and
Tax withheld and
city, state, ZIP code
gas proceeds
paid by the remitter
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
Check one:
FEIN
Check if outside the U.S.
SSN
If more space is needed, print the Supplemental page directly from
2.
Line 2. Total withholding this page.
the website and attach the additional supplemental pages to the
first page of this report. Reproducing from a photocopy reduces the
readability of the bar code on scanning equipment.
OGP-D
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