Form Rpd-41367 12 - Annual Withholding Of Net Income From A Pass-Through Entity Detail Report - New Mexico Taxation And Revenue Department Page 2

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RPD-41367 12
New Mexico Taxation and Revenue Department
*129090200*
Rev. 12/04/2012
2012 Annual Withholding of Net Income
From a Pass-Through Entity Detail Report
- Supplemental Form -
PTE’s FEIN
Pass-through entity’s name
Page ______ of _______
Col. 5
Owner’s name,
Column 2
Column 3
Column 4
RPD-41353
Owner’s SSN/FEIN
Owner’s share of
Owner’s share of
street address,
on file
allocable net income
withholding tax
city, state, ZIP code
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
YES
Check one:
FEIN
SSN
Check if outside the U.S.
If more space is needed, print the Supplemental Form directly
from the website and attach the additional supplemental forms
2.
Line 2. Total withholding
to the first page of this form. Reproducing from a photocopy
this page.
reduces the readability of the bar code on scanning equipment.
PTW-D

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