Form Ogp-D - Annual Withholding Of Oil And Gas Proceeds Detail Report - 2011

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RPD-41360
New Mexico Taxation and Revenue Department
*118280200*
Rev. 8/8/2012
2011 Annual Withholding of Oil and Gas
Proceeds Detail Report
1
Page ______ of _______
Check if amended
Remitter’s FEIN or SSN
Line 1. Total New Mexico gross oil and
Remitter’s name
gas proceeds distributed by the remitter.
Check one:
FEIN
SSN
Remittee’s name,
Column 2
Column 3
Column 4
Remittee’s SSN/FEIN
Remittee’s oil and
Tax withheld and
street address,
gas proceeds
paid by the remitter
city, state, ZIP code
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
File this report on-line using the Department’s web site at
Line 2. Total withholding this page.
2.
https://efile.state.nm.us. If you cannot electronically file, see
the instructions. For assistance completing this return call
Line 3. Total withholding from all
(505) 827-0825.
pages.
3.
I declare I have examined this form and to the best of my knowledge and belief it is true, correct and complete.
Authorized signature ___________________________________________________ Date ____________________________________________
Phone number ___________________________________ E-mail address _________________________________________________________
OGP-D

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