Form Mt-7 - Initial Oil Or Gas Exemption Request printable pdf download

KANSAS DEPARTMENT OF REVENUE

DIVISION OF TAXATION

CUSTOMER RELATIONS

Mineral Tax Section

Topeka, Kansas 66625-0918

INITIAL OIL OR GAS EXEMPTION REQUEST

Application is hereby made to the Director of Taxation to exempt the following lease or well from Kansas Mineral Tax. Application is made with full knowledge of the penalties as

prescribed by law. See instructions on back of this form. Return completed form to the address above.

OFFICE USE ONLY

EXEMPTION STATUS

______________________________________________________________ Operator Name

Exemption Approved: ____ Yes ____ No

______________________________________________________________

Address

Approved Exemption No.:

____________

______________________________________________________________

Address

Effective Date:

_____________________

______________________________________________________________ City, State, Zip Code

Termination Date:

__________________

LEASE INFORMATION (MANDATORY FOR ALL EXEMPTIONS)

Reason for Exemption (check only one): _____ Minimum Production

_____ Incremental

_____ Water Flood _____ New Pool

_____ Tertiary

KCC Operator I. D. Number: ________________________

Operator Phone Number: _____________________________

If Oil Well, Kansas Oil Lease/ Well Number: _1_ ___ ___ ___ ___ ___.

If Gas Well, Kansas Gas Lease/ Well Number: _2_ ___ ___ ___ ___ ___.

Lease Name: _______________________________________________ County Name: _____________________________________________

Legal Description: Sec. ____________ Twn. ____________ Rng ____________

Average Depth of Producing Wells: ______________

Number of Producing Wells on Lease (Injection wells are not counted as producing wells): _________

Name of Producing Formation: _______________________________________________ Field Name: ______________________________________________

COMPLETE IF WATER FLOOD OR MINIMUM PRODUCTION EXEMPTION

Average Daily Production is ___________BOPD. This is for the most recent six month period beginning _____________________ and ending _____________________.

See back of this form for more detail in calculating average daily production and current exemption levels.

Do not send this form if Average Daily Production is above the minimun level.

If Water Flood Exemption, is production gauged separately?

______ Yes

______ No

If Water Flood Exemption, what is the docket number from the KCC Enhanced Recovery Order: __________________

COMPLETE IF NEW POOL EXEMPTION

What is the Docket Number issued by the KCC? _________________

The New Pool Exemption is valid for 2 years from the KCC certified date of first production. KCC certified date: _________________________________

Is New Pool production commingled? _____ Yes

_____ No

If yes, indicate:

_____ Downhole

_____ In Tank

_____ At Meter

COMPLETE IF INCREMENTAL OR TERTIARY EXEMPTION

The KCC must certify all enhancement projects prior to exemptions being granted. Incremental Exemptions are granted on a well basis only.

If Incremental Exemption, what is the certified KCC enhancement project number? ________________________________

The Incremental Exemption is valid for 7 years from the KCC certified startup date. KCC certified date: ________________________________________

If Tertiary Exemption, the enhanced recovery permit number is: _____________________________ KCC start date: _______________________________

Additional information is on the back of this form. If you have further questions, please call (785) 296-7713.

I declare under the penalties of perjury that all the required KCC certifications have been received and this application is true and correct.

___________________________________________ __________________

New Pools are required to submit a copy of the KCC

Signature of Authorized Officer or Agent

Date

Certification letter with this form.

_______________________________________________________ Purchaser Name & I. D. Number

_______________________________________________________

Address

Print operator’s & purchaser’s address clearly, they will

_______________________________________________________

Address

be used as mailing labels.

_______________________________________________________ City, State, Zip Code

DEPARTMENT’S COPY

MT-7 (Rev. 10/07)

Form Mt-7 - Initial Oil Or Gas Exemption Request

Related Articles

Related forms

Related Categories