Form 10-171 - Amended Natural Gas Tax 2010
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1
210-171
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(Rev.2-08/2)
b.
37110
a.
Page ______ of ______
Amended Natural Gas Tax
c. Taxpayer number
d. Filing period
-- PURCHASER 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
11. Producer's name
11. Producer's name
12. Producer
12. Producer
number
number
Enter adjusted data in Items 13 - 22.
Enter adjusted data in Items 13 - 22.
YES
NO
YES
NO
13. Is tax reimbursement included in
13. Is tax reimbursement included in
1
2
1
2
calculating the value on this lease?
calculating the value on this lease?
14. Your
14. Your
volume
volume
$
$
15. Value of
15. Value of
your volume
your volume
YES
NO
YES
NO
1
2
1
2
16. Are you liable for the tax?
16. Are you liable for the tax?
17. Governmental
17. Governmental
royalty volume
royalty volume
$
$
18. Governmental
18. Governmental
royalty value
royalty value
$
$
19. Marketing
19. Marketing
cost
cost
$
$
20. Net taxable
20. Net taxable
value
value
Items 21 and 22 for Exemption Type 05 leases only.
Items 21 and 22 for Exemption Type 05 leases only.
21. Type 05 reduced tax rate
21. Type 05 reduced tax rate
$
$
22. Tax due on
22. Tax due on
Type 05
Type 05
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