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Form Rpd-41367 - Ptw Detail Report For Annual Withholding Of Net Income From A Pass-Through Entity - 2015 Page 2

New Mexico Taxation and Revenue Department

*159090200*

2015 PTW Detail Report For Annual

Withholding of Net Income From a

Pass-Through Entity, Form RPD-41367

Supplemental Page

Pass-through entity’s name

PTE’s FEIN

Page ______ of _______

Col. 5

Owner’s name,

Column 2

Column 3

Column 4

On file

Owner’s SSN

Owner’s share of

street address,

RPD-41353

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 - Ptw Detail Report For Annual Withholding Of Net Income From A Pass-Through Entity - 2015 Page 2

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