Form Rpd-41374 - 2013 Annual Report Of Non-Resident Remittees Holding An Agreement To Pay Tax On Oil And Gas Proceeds

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RPD-41374 (2013)
*134080200*
New Mexico Taxation and Revenue Department
Rev. 5/3/2013
2013 Annual Report of Non-Resident
Remittees Holding an Agreement to Pay
Tax on Oil and Gas Proceeds
1
Page ______ of _______
Check if amended
Line 1. Total New Mexico gross oil and
Remitter’s name
Remitter’s FEIN or SSN
gas proceeds distributed by the remitter.
Check one:
FEIN
SSN
Remitter’s address, city, state, and ZIP code
Column 2
Column 3
Column 4
Remittee’s name,
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 website at
2.
Line 2. Total this page.
https://efile.state.nm.us. If you cannot electronically file, see
the instructions. For assistance completing this return call
3.
Line 3. Total from all pages.
(505) 827-0825.
I declare I have examined this report 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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