RPD-41201
Rev. 02/27/2024                              New Mexico Taxation and Revenue Department
                                         New Mexico Report of Unclaimed Property
                                                              Unclaimed Property Office 
                                                              P.O. Box 25123 
                                                 Santa Fe, New Mexico 87504-5123

File on or before November 1 (May 1 for life insurance). If the due date falls on a weekend or holiday, the report is due the next business day and be-
comes delinquent on the first day thereafter.
Section 1
1.  FILING STATUS         c     First Filing    c     Annual Report 20______  c     Verification for Period Ended _______________, 20______
    Mark only one box.
                          c     Amended         c     Safety Deposit Boxes    c     Supplemental
2.  Name of Holder                                                                               3.     FEIN, SSN, or ITIN

4.  Mailing Address - City, State, Zip Code

5.  Name of Contact Person                                          6.       Contact Phone Number

7.  Contact Email Address                                                                                 c     RPD-41202    c     RPD-41203
                                                                    8.       Forms Attached:
                                                                             Mark all applicable          c     RPD-41204
Section 2
9.  Do any other departments, branches, or subsidiaries file reports using this same FEIN, SSN, or ITIN ?    Yes  c     No  c
10. Primary Business Activity

11. Did holder file a report of Unclaimed Property last year? Yes  c     No  c
12.  If no on previous item, please explain.

13. If holder is a successor, list the name(s) and FEIN(s), SSN(s), or ITIN(s) of all previous holders of the property. If holder changed name during the 
    time in which they held the property, list the prior name(s), state of incorporation, date the corporation changed names and FEIN(s), SSN(s), or ITIN(s)

Section 3
Holders remittance and confirmation of shares transferred into New Mexico (if applicable) must accompany this report.

14.   c     Stock sent to Mellon Security Trust                     15.       Total amount due from last page

16.   c     Copy of Stock                                           17.       Penalty

18. CUSIP Number                                                    19.  Interest

                                                                    20.       Total Remittance
21. Total Number of Shares

Section 4: Official Verification Report
I declare that I have examined this return and the information reported on this form and attached schedules is true and correct as to every material matter.
22. Printed Name                                                                                 23.    Title

24.  Signature                                                                                   25.  Date

RPD-41201
Rev. 02/27/2024                   New Mexico Taxation and Revenue Department
                                 New Mexico Report of Unclaimed Property
                                                   Instructions
This form is used to summarize the report information from               brief explanation.
RPD-41202,      List of Owners of Unclaimed Property, RPD-           13. Successor and changed name
41203,  List of Owners of Unclaimed Stock and Other Secu-                If holder is a successor, list the name(s) and FEIN(s), 
rities, and RPD-41204, List of Unclaimed Contents of Safe                SSN(s), or ITIN(s) of all previous holders of the property. 
Deposit Boxes/Other Safekeeping Repositories.                            If holder changed name during the time in which they held 
                                                                         the property, list the prior name(s), state of incorpora-
Whenever possible, the Unclaimed Property Office (UPO )                  tion, date the corporation changed names and FEIN(s), 
encourage all holders to report their unclaimed property to              SSN(s), or ITIN(s).
the UPO electronically online at http://holdernm.unclaimed-
property.com/.                                                       Section 3
                                                                     14. Stock sent to Mellon Security Trust
The Taxation and Revenue Department (Department) will                    Mark box to indicate that stocks indicated on RPD-41203 
ONLY accept electronic data in the NAUPA (National Un-                   have been delivered to the Taxation and Revenue Depart-
claimed Property Administrators) format.  Note:    The UPO               ments (Department) transfer agent.
no longer accepts electronic media such as USB Drive or              15. Total amount due from last page
compact disks. Computer listings cannot be accepted in lieu              Enter the total amount due of all pages of RPD-41202, 
of the approved reporting forms unless all required data fields          RPD-41203, and RPD-41204 as applicable to this return.
are included on the printout. Property type codes must appear        16. Copy of Stock
on the printout.                                                         Mark box to indicate that shares have been delivered to 
                                                                         the Departments stock custodian. 
Effective July 1, 2006, all reports containing more than 25          17. Penalty
properties are required to be submitted electronically.                  Enter the amount of penalty applicable. 
                                                                         • A holder who fails to report, pay or deliver property 
FORM INSTRUCTIONS                                                          within the time prescribed by the Uniform Unclaimed 
                                                                           Property Act (1995), or fails to perform other duties 
Section 1                                                                  imposed by that act, shall pay a penalty of one hun-
1.  Filing Status                                                          dred dollars ($100) for each day the report, payment 
    Mark  only  one  box  to  indicate  filing  status.  If  marking       or delivery is withheld, or the duty is not performed, 
    "Annual Report 20"  indicate the year this report if for. If           up to a maximum of five thousand dollars ($5,000).
    marking "Verification for Period Ended" indicate the month           • A holder who willfully fails to report, pay or deliver 
    and year this report is for.                                           property within the time prescribed by the Uniform 
2.  Name of Holder                                                         Unclaimed  Property Act  (1995),  or  willfully  fails  to 
    Enter the name of the holder.                                          perform other duties imposed by that act, shall pay 
3.  FEIN, SSN, or ITIN                                                     a penalty of two hundred fifty dollars ($250) for each 
    Enter the FEIN, SSN, or ITIN of the holder.                            day the report, payment or delivery is withheld, or 
4.  Mailing Address - City, State, Zip Code                                the duty is not performed, up to a maximum of seven 
    Enter the complete mailing address of the holder.                      thousand five hundred dollars ($7,500), plus twenty-
5.  Name of Contact Person                                                 five percent of the value of any property that should 
    Enter contact person's name.                                           have been but was not reported.
6.  Contact Phone Number                                                 • A holder who makes a fraudulent report shall pay a 
    Enter contact person's phone number.                                   penalty of five hundred dollars ($500) for each day 
7.  Contact Email Address                                                  from the date a report under the Uniform Unclaimed 
    Enter contact person's email address.                                  Property Act (1995) was due, up to a maximum of 
8.  Forms Attached                                                         twelve thousand five hundred dollars ($12,500), plus 
    Mark all forms that included with this report.                         twenty-five percent of the value of any property that 
Section 2                                                                  should have been but was not reported.
9.  Do any other departments, branches, or subsidiaries              18. CUSIP Number
    file reports using this same FEIN, SSN, or ITIN?                     Enter holder's Committee on Uniform Securities Identifica-
    Mark only one box to indicate yes or no to question.                 tion Procedures (CUSIP) number, which consists of nine 
10. Primary Business Activity                                            characters (including letters and numbers) that uniquely 
    Briefly describe the nature of the type(s) of business in            identifies a company or issuer and the type of financial 
    which you are engaging.                                              instrument. The CUSIP number is issued by the CUSIP 
11. Did holder file a report of Unclaimed Property last year?            Service Bureau, which is operated by the American Bank-
    Mark only one box to indicate yes or no to question.                 ers Association.
12. If no on previous item, please explain
    If you indicated no to the previous question provide a 

RPD-41201
Rev. 02/27/2024                      New Mexico Taxation and Revenue Department
                                New Mexico Report of Unclaimed Property
                                                 Instructions
19. Interest
    Add interest if the holder fails to report, pay or deliver 
    property timely the property or value thereof from the 
    date the property  should  have been  reported, paid  or 
    delivered. Interest accrues daily on the unpaid principal  
    property or value thereof, and it can change on a quar-
    terly basis.

    Interest is calculated daily but the rate will be set at the 
    rate established for individual income tax purposes by 
    the  U.S.  Internal  Revenue  Code  (IRC). The  IRC  rate, 
    which changes quarterly, is announced by the IRS in the 
    last month of the previous quarter. The annual and daily 
    interest rates for each quarter are posted on our website 
    at   https://www.tax.newmexico.gov/individuals/fileyour-
    taxes-overview/penalty-interest-rates/.

    Tax Due X Daily Interest Rate for the Quarter X Number 
    of Days Late = Interest Due.
20. Total Remittance
    Enter the total remittance of all pages of RPD-41202, 
    RPD-41203, and RPD-41204 as applicable to this return.
21. Total Number of Shares
    Enter the total number of shares from RPD-41203.

Section 4: Official Verification Report
22. Printed Name
    Enter the printed name of signer.
23. Title
    Enter the title of signer.
24. Signature
    Enter signature.
25. Date
    Enter the date this form is signed. Use the date format 
    mm/dd/ccyy.

If you have any questions please contact the Unclaimed 
Property Office at:

         New Mexico Taxation & Revenue Department
                Unclaimed Property Office
                    P.O. Box 25123
                Santa Fe, New Mexico 87504-5123
                Unclaimed.Property@tax.nm.gov
                    505-827-0668