Form Rpd-41160 - Information Return - Indian Intergovernmental Tax Credit printable pdf download

Form Rpd-41160 - Information Return - Indian Intergovernmental Tax Credit

RPD - 41160

STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT

REV. 11/00

INFORMATION RETURN

INDIAN INTERGOVERNMENTAL TAX CREDIT

(FORM RPD - 41160)

Name of Individual, Firm or Organization

OGRID Number

Contact Person

Telephone Number

Mailing Address

City

State

Zip Code

Please check one:

❑ Well Operator

❑ Working Interest Owner

❑ Purchaser

PUN ....................................................................

WELL OPERATOR NAME .................................

PROPERTY NAME ............................................

POOL NAME ......................................................

30 -

API NUMBER .....................................................

WELL NUMBER AND UNIT LETTER ................

SECTION, TOWNSHIP AND RANGE ...............

DATE DRILLING COMMENCED .......................

DATE OF FIRST PRODUCTION .......................

INDIAN TRIBE ...................................................

LEASE NUMBER ...............................................

Mail or deliver the completed form to:

New Mexico Taxation and Revenue Department

Oil and Gas Bureau

1200 South St. Francis Drive

P. O. Box 5374

Santa Fe, NM 87502-5374

Telephone: (505) 827-0805

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Form Rpd-41160 - Information Return - Indian Intergovernmental Tax Credit