Form Rpd-41344 - Native American Veterans Income Tax Settlement Fund Claim Page 4

ADVERTISEMENT

RPD-41344
State of New Mexico - Department of Veterans Services
Rev. 07/2010
NATIVE AMERICAN VETERANS
Income Tax Settlement Fund Claim
(Page 3 of 3)
Part 6. Continued.
(1)
(2)
(3)
(4)
Amount of New Mexico income
I request the Taxation and Reve-
To the best of my knowledge, I
Tax year
tax withheld from the attached
nue Department obtain the claim-
certify that a refund for the taxes
copy of Forms W2. Enter "Do
ant's Form W2 information for the
withheld (check only one box):
not have W2" if you do not have
tax year.
a Form W2 for the year.
‰
was received
‰
$
Yes
‰
was not received
‰
was received
$
‰
Yes
‰
was not received
$
‰
was received
‰
Yes
‰
was not received
$
‰
was received
‰
Yes
‰
was not received
$
‰
was received
‰
Yes
‰
$
was not received
‰
was received
$
‰
Yes
‰
was not received
Total of Column 2.
Part 7. Signature of Claimant
I declare I have examined this application, including accompanying schedules, statements and attachments, and to
the best of my knowledge and belief it is true, correct and complete.
Signature of veteran or if deceased, personal representative or legal successor
Print name
Date
FOR DEPARTMENT USE ONLY
Verification of Veteran's Status by the Department of Veterans Services
The Department of Veterans Services has examined the veteran's information and has verified that the application,
including accompanying schedules, statements and attachments, is true, correct and complete according to the records
available to the Department. The application is ready for review by the Taxation and Revenue Department.
Secretary of Department of Veterans Services or delegate
Print name
Title
Date

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Rpd-41344 - Native American Veterans Income Tax Settlement Fund Claim Form Rpd-41344 - Native American Veterans Income Tax Settlement Fund Claim Financial
Form Rpd-41344 - Native American Veterans Income Tax Settlement Fund Claim - State Of New Mexico Department Of Veterans Services Form Rpd-41344 - Native American Veterans Income Tax Settlement Fund Claim - State Of New Mexico Department Of Veterans Services Financial
Form Rpd-41344 - New Mexico Native American Veterans Income Tax Settlement Fund Claim Form Rpd-41344 - New Mexico Native American Veterans Income Tax Settlement Fund Claim Financial
Instructions For Form Rpd-41344 - Income Tax Settlement Fund Claim Instructions For Form Rpd-41344 - Income Tax Settlement Fund Claim Financial
Dd Form 2058-2 - Native American State Income Tax Withholding Exemption Certificate Privacy Act Statement Form Dd Form 2058-2 - Native American State Income Tax Withholding Exemption Certificate Privacy Act Statement Form Legal
Form Ppb-8a - Disabled American Veteran Property Tax Relief Application Form Ppb-8a - Disabled American Veteran Property Tax Relief Application Financial
Form Rpd-41371 - Application For Veteran Employment Tax Credit - State Of New Mexico Taxation And Revenue Department Form Rpd-41371 - Application For Veteran Employment Tax Credit - State Of New Mexico Taxation And Revenue Department Financial
Form Rpd-41371 - Application For Veteran Employment Tax Credit Form Rpd-41371 - Application For Veteran Employment Tax Credit Financial
Form Rpd-41371 - Application For Veteran Employment Tax Credit Form Rpd-41371 - Application For Veteran Employment Tax Credit Financial
Form Rpd-41371 - Application For Veteran Employment Tax Credit Form Rpd-41371 - Application For Veteran Employment Tax Credit Financial

Related Categories

Parent category: Financial
Download
Go
Page of 5