Form Rpd-41367 - Annual Withholding Of Net Income From A Pass-Through Entity Detail Report - 2013 Page 2

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RPD-41367 (2013)
New Mexico Taxation and Revenue Department
*139090200*
Rev. 08/08/2013
2013 Annual Withholding of Net Income
From a Pass-Through Entity Detail Report
- Supplemental Form -
Pass-through entity’s name
PTE’s FEIN
Page
of
Column 1
Col. 5
Column 2
Column 3
Column 4
RPD-41353
Owner’s name, street address,
Owner’s SSN/FEIN
Owner’s share of
Owner’s share of
on file
city, state, ZIP code
withholding tax
allocable net income
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.
Line 2. Total withholding
If more space is needed, print the Supplemental Form directly
2.
this page.
from the website and attach the additional supplemental forms
to the first page of this form. Reproducing from a photocopy
reduces the readability of the bar code on scanning equipment.
PTW-D

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