Form Rpd-41367 - Ptw Detail Report For Annual Withholding Of Net Income From A Pass-Through Entity - 2015 Page 3
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3RPD-41359
New Mexico Taxation and Revenue Department
Rev. 08/27/2014
Annual Statement of Pass-Through Entity Withholding
Pass-through entity’s federal employer identification number
Tax Year
(FEIN)
Pass-through entity’s name, street address, city,
Pass-through entity’s CRS identification number (optional)
state, ZIP code, and phone number
Owner’s federal identification number
Mark box if address
Mark one
FEIN
outside the U.S.
box
SSN
Owner’s name, street address, city, state, and
New Mexico net income of the owner from the pass-through
entity
ZIP code
New Mexico state tax withheld
Mark box if address
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. 08/27/2014
Annual Statement of Pass-Through Entity Withholding
Tax Year
Pass-through entity’s federal employer identification number
(FEIN)
Pass-through entity’s name, street address, city,
Pass-through entity’s CRS identification number (optional)
state, ZIP code, and phone number
Owner’s federal identification number
Mark box if address
Mark one
FEIN
outside the U.S.
box
SSN
Owner’s name, street address, city, state, and
New Mexico net income of the owner from the pass-through
entity
ZIP code
New Mexico state tax withheld
Mark box if address
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. 08/27/2014
Annual Statement of Pass-Through Entity Withholding
Tax Year
Pass-through entity’s federal employer identification number
(FEIN)
Pass-through entity’s name, street address, city,
Pass-through entity’s CRS identification number (optional)
state, ZIP code, and phone number
Owner’s federal identification number
Mark box if address
Mark one
FEIN
outside the U.S.
box
SSN
Owner’s name, street address, city, state, and
New Mexico net income of the owner from the pass-through
entity
ZIP code
New Mexico state tax withheld
Mark box if address
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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