SEVERANCE TAX REPORT OIL

Transcription

1 2 West 25th Street ** Taxpayer s Operator ID as assigned by the Taxpayer s name. Do not enter an 2 Wyoming Oil and Gas Conservation agent s name here. S ONLY. Commission (WOGCC), or as assigned by 4 the Mineral Tax Division. Contact Person or Agent's telephone number including area code and extension. NOTE: A change in Rate Code 5 for the originally reported rate 9 will not reflect previous tax applied 10 Use Form to report oil and lease condensate (liquids separated at the lease). for tax previously applied to your Enter O for an original report. Enter A for an amended report. Name of the person, agent, or agency responsible for completing this report who can answer questions regarding this report. Always report volumes and values except Total Tax Due rounded to the nearest whole number. Total Tax Due must be reported to the cent.

2 2 West 25th Street ** Month and year. If you are an annual filer 2 report production for the entire year as December S ONLY. (yyyy). 4 Enter the five digit Reporting Group Number NOTE: A change in Rate Code assigned by the Mineral Tax Division. 5 for the originally reported rate Enter the proper Rate Code Identifier for the Reporting Group (see Rate Code Table). Form is used to enter the combined Rate Code total for a specific Reporting Group. Individual wells in a Reporting Group that qualify for well incentives must also be itemized on Form will not reflect previous tax applied Operators enter barrels sold, after deducting 10 for tax previously applied to your barrels taken in-kind. Take In-Kind interest owners enter barrels taken in-kind. 2 West 25th Street **

3 Enter the gross sales value for the production 2 period. Gross Sales Value includes all S ONLY. revenue relating to the production for the reported period, including tax 4 reimbursements and all other revenue Enter the remainder of NOTE: A change in Rate Code received or credited to all interest owners not Gross Sales Value minus 5 taking in-kind and reporting on their own Exempt Royalty and for the originally reported rate behalf, and including all Federal, State, or Transportation. Tribal royalty owner's interest. 8 Enter the value of the Federal, State, or Tribal NOTE: For amendments Total Royalty exemption, if any, plus transportation 9 will not reflect previous tax applied "to market" costs which occur between the well head and point of sale for which you can 10 for tax previously applied to your produce invoices for verification. 2 West 25th Street **

4 Equals the taxable value times the applicable tax rate per the Rate Code Table. 2 S ONLY. 4 NOTE: A change in Rate Code Rate Rate Severance Code Mineral Type Description Tax Rate 5 for the originally reported rate BAS Oil Group No Incentives (base rate) S10 Oil Group Stripper up to 10 barrels per day.040 new rate code. S15 Oil Group Stripper between 11 bbls and 15 bbls per day.040 LCD Oil Group Lease Condensate.060 REN Oil Well Renewed Production.015 NOTE: Reporting Groups containing wells that qualify for well incentives, Rate Type Well, must 9 complete and attach 2002, Severance Tax Schedule. will not reflect previous tax applied 10 for tax previously applied to your Severance Rate Code Table for Oil 2 West 25th Street **

5 Severance Tax Forms and payment in full must be post-marked by the 25 th day of 2 S ONLY. 4 NOTE: A change in Rate Code production year. All delinquent severance taxes are subject to penalty and 5 interest. for the originally reported rate Mineral Tax Division 9 2 West 25th Street will not reflect previous tax applied 10 Cheyenne, WY for tax previously applied to your the second month following the month of production. If a taxpayer s total liability for severance tax was less than $0,000 for the preceding calendar year, the taxpayer can report annually, by February 25th of the year following the The mailing address for all mineral forms is: Wyoming All paper forms must be signed and dated originals.

6 2 West 25th Street 1 2 ADDRESS: CITY: STATE: ** ZIP: 4 NOTE: For amended returns (Form Type A ) report REPLACEMENT 5 S ONLY. 6 NOTE: A change in Rate Code requires BOTH an amended report for the originally reported rate code and an original report for the NEW rate code. 8 9 NOTE: For amendments Total Tax Due is the replacement amount and will not 10 reflect previous tax applied to your account. Be sure to account for tax 11 Previously applied to your account prior to remitting the current payment. Rev 09/16/2011