2010 FID-WD
New Mexico
Withholding Tax Distributions for Simple and Grantor Trusts
(Duplicate page if additional page is needed.)
Page _______ of _______
FEIN of trust
Name of trust
Beneficiary's Information
COLUMN 5
COLUMN 1
COLUMN 2
COLUMN 6
COLUMN 3
COLUMN 4
Owner's Share of
Name
Address
Withholding
Social Security
Percentage of
Oil and Gas
Distributed
Number/FEIN
Ownership
Proceeds
Total Withholding Tax for Page
Total Withholding Tax for All Pages