RPD-41354                STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
Rev. 10/04/2011
                  DECLARATION OF PRINCIPAL PLACE OF BUSINESS OR 
                                        RESIDENCE IN NEW MEXICO
Purpose of this form: Corporations whose principal place of business is in New Mexico and individuals who are residents of New 
Mexico, who are recipients of oil and gas proceeds from a well located in New Mexico or owners of a pass-through entity (PTE) 
earning income sourced to New Mexico, are to submit this form to the payor to establish that oil and gas proceeds withholding tax 
or pass-through entity withholding tax is not required on their net income or receipts of oil and gas proceeds.   
Effective January 1, 2011, remitters of oil and gas proceeds and pass-through entities are not required to withhold from: 1) corpo-
rations whose principal place of business is in New Mexico, or 2) individuals who are residents of New Mexico. If the corporation 
establishes that its principal place of business is in New Mexico or an individual establishes that his or her residence is in New 
Mexico, it does not matter where remittances to the corporation or individual are sent. To establish that you are not subject to the 
withholding required under the Oil and Gas Proceeds and Pass-through Entity Withholding Tax Act, you must submit this form to 
the remitter or the PTE. 
To ease the transition to the new requirement, remitters of oil and gas proceeds may continue to rely on a New Mexico address 
to establish residency in New Mexico or a principal location in New Mexico for withholding for calendar quarters ending prior to 
January 1, 2012. After this date, the remitter must have this document, or other documentation to show reasonable cause for not 
withholding. See the instructions for Forms RPD-41284, Quarterly Oil and Gas Proceeds Withholding Tax Return, or RPD-41355, 
Quarterly Pass-Through Entity Withholding Tax Return, for a discussion of the types of documentation that are acceptable as proof 
that withholding is not required. 
A permanent residence or place of business is a permanent physical location or abode. The permanent residence or place of 
business is not a post ofce box number, address of a postal forwarding service or equivalent address or the address of a bank, 
agent or nominee. 
If the circumstances for the individual or the corporation changes, the individual or the corporation must notify the remitter or the 
PTE at once. If the individual changes domicile to outside New Mexico, or a corporation moves its principal place of business to 
a location outside New Mexico, the remitter or the PTE will then be required to withhold against the owner’s net income from the 
pass-through entity or the remittee’s oil and gas proceeds provided that no other reasonable cause for not withholding exists.  
A PTE who is an owner or a remittee may not submit this form to avoid the withholding tax requirement of a paying PTE or remitter. 
The PTE owner or PTE remittee may submit Form RPD-41353, Owner’s or Remittee’s Agreement to Pay Withholding On Behalf 
of a Pass-Through Entity or Remitter, or other documentation as proof of reasonable cause for not withholding from an owner or 
remittee as described in the instructions for Forms RPD-41356, Pass-Through Entity Owner’s Quarterly Tax Payment, and RPD-
41357, Oil and Gas Proceeds Remittee’s Quarterly Tax Payment, under the section, “Exceptions to the Requirement to Withhold”.
Note: When revisions to this form occur the previous version will satisfy the documentation requirements for establishing that the 
remittee or owner is a New Mexico resident or maintains a principal place of business in New Mexico. A new declaration need not 
be obtained from the remittee or owner. 
Name (please print)                                               Federal identication number (SSN or FEIN) 

Permanent residence or place of business - physical location only 

City, state and ZIP code                                          Telephone number

Check One:
‡    I am a resident of New Mexico for tax purposes because I am domiciled in New Mexico, which means 
     New Mexico is my permanent home; I must le or intend to le a New Mexico tax return as a resident 
     or rst-year resident, and I am domiciled in New Mexico on the last day of the taxable year, December 
     31. 
‡    The business is a corporation whose principal place of business is located in New Mexico, which means 
     there is a physical location in New Mexico from which the business or trade is directed or managed.
  I declare under penalty of perjury that I have completed this document and to the best of my knowledge, it is 
  true, correct and complete. 

  Signature _________________________________________ Date _____________

  Title __________________________________