Form 10-173 - Amended Natural Gas Tax - Producer Lease Detail Supplement - 2008
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10-173
(Rev.2-08/2)
b.
49110
a.
Page ______ of ______
Amended Natural Gas Tax
c. Taxpayer number
d. Filing period
-- PRODUCER LEASE DETAIL SUPPLEMENT --
f.
e. Taxpayer name
LOCATOR NUMBER
LOCATOR NUMBER
1. Lease name (as recorded with the Railroad Commission)
1. Lease name (as recorded with the Railroad Commission)
2. County of production
2. County of production
3. Commodity
3. Commodity
(Use the alpha codes listed in the instructions.)
(Use the alpha codes listed in the instructions.)
4. Commodity code
4. Commodity code
(Numeric)
(Numeric)
OIL
GAS
OIL
GAS
5. Lease type
5. Lease type
1
2
1
2
6. County code
6. County code
Check
Check
digit
digit
7. Lease number
7. Lease number
YES
NO
YES
NO
1
2
1
2
8. Is Item 7 a drilling permit number?
8. Is Item 7 a drilling permit number?
9. Exemption type
9. Exemption type
10. API number
10. API number
YES
NO
YES
NO
1
2
1
2
11. Is this an off-lease sale?.
11. Is this an off-lease sale?.
12. Purchaser's name
12. Purchaser's name
13. Purchaser
13. Purchaser
number
number
Enter adjusted data in Items 14 - 24.
Enter adjusted data in Items 14 - 24.
14. Total lease
14. Total lease
volume
volume
YES
NO
YES
NO
15. Is tax reimbursement included in
15. Is tax reimbursement included in
1
2
1
2
calculating the value on this lease?
calculating the value on this lease?
16. Your
16. Your
volume
volume
$
$
17. Value of
17. Value of
your volume
your volume
YES
NO
YES
NO
18. Are you liable for the tax?
18. Are you liable for the tax?
1
2
1
2
(If "NO," do not complete Items 19-24.)
(If "NO," do not complete Items 19-24.)
19. Governmental
19. Governmental
royalty volume
royalty volume
$
$
20. Governmental
20. Governmental
royalty value
royalty value
$
$
21. Marketing
21. Marketing
cost
cost
$
$
22. Net taxable
22. Net taxable
value
value
Items 23 and 24 for Exemption Type 05 leases only.
Items 23 and 24 for Exemption Type 05 leases only.
23. Type 05 reduced tax rate
23. Type 05 reduced tax rate
$
$
24. Tax due on
24. Tax due on
Type 05
Type 05
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