Form 10-174 - Amended Crude Oil Tax - Producer Special Report - 2008/2
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1
210-174
(Rev.4-08/2)
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b.
48150
a.
under Chapters 552 and 559, Government Code, to
You have certain rights
review, request and correct information we have on file about you. Contact us
at the address or toll-free number listed on this form.
Texas Comptroller of Public Accounts
AMENDED CRUDE OIL Tax -- PRODUCER SPECIAL Report
Page 1 of ______
c. Taxpayer number
d. Due date
e. Filing period
f.
FM
h.
i.
Taxpayer name and mailing address
g.
Blacken this box if your address has changed.
1
THIS REPORT PAGE MUST ACCOMPANY ANY LEASE
DETAIL SUPPLEMENT PAGES (Form 10-175) FOR THIS
PLEASE INDICATE REASON
REPORTING PERIOD. It is recommended that supplement
LOST
STOLEN
UNACCOUNTED FOR
pages be completed prior to completing this page.
OTHER
SUMMARY DATA - (See instructions)
1. Total taxable barrels from lease detail supplements
(Total from Item 16 on all attached Lease Detail Supplements, Form 10-165. Enter whole barrels.) 1.
2. Total net taxable value from lease detail supplements
$
(Total from Item 20 on all attached Lease Detail Supplements, Form 10-165. Enter dollars and cents.)
2.
3. Regulatory tax and fee assessment
$
(Multiply Item 1 x
. Enter dollars and cents.)
3.
4. Tax due
$
(Multiply Item 2 x
. Enter dollars and cents.)
4.
5. Total tax and fee due
$
(Add Items 3 and 4. Enter dollars and cents.)
5.
10-174
(Rev.4-08/2)
* * * DO NOT DETACH * * *
$
6. Overpayment
6.
(Credit Transfer Form for Crude Oil Tax, Form 10-141, must be included.)
$
7. Net amount due
7.
(Item 5 minus Item 6)
$
8. Penalty & Interest
8.
(If tax is paid after the due date, see instructions.)
$
9. TOTAL AMOUNT DUE AND PAYABLE
(Item 7 plus Item 8)
9.
Taxpayer name
l.
T Code
Taxpayer number
Period
Make the amount in Item 9 payable to:
48020
48020
STATE COMPTROLLER
Mail to:
I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief.
COMPTROLLER OF PUBLIC ACCOUNTS
Print name
Business phone (Area code and number)
P.O. Box 149358
Austin, Texas 78714-9358
Taxpayer or duly authorized agent
Date
m.
777
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