Form Dr 145x - Oil Production Monthly Amended Tax Return
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1
2DR-145X
Oil Production Monthly Amended Tax Return
R. 04/03
Mail to:
FEIN:
Florida Department of Revenue
5050 W. Tennessee Street
Applied Period:
Tallahassee, Florida 32399-0150
For RDS validation use only - Do not write or stamp in this space.
Name: ________________________________________________
Address: ______________________________________________
City: _______________________ State: ________ ZIP: _________
❑
Check here if you have electronically
transmitted funds (EFT)
A
B
Ordinary
Small Well/
Oil
Tertiary
1.
Tax Due
$
$
(from line 6, Schedule I and Schedule II)
2.
Total Net Change in Gross Value of any Escaped Oil
2. $ ____________________
(from line 2, Schedule III)
3.
Tax Due on Escaped Oil
3. $ ____________________
(12.5% of line 2)
4.
DOR Credit Memo Issued
4. $ ____________________
(attach original credit memo)
5.
Total Tax Due
5. $ ____________________
(total of line 1, columns A and B plus line 3 minus line 4)
6.
Penalty and Interest
(enter penalty and interest if return is postmarked after
the 25th of the following month)
6a. Delinquency Penalty
(10% per month on all tax not paid by
6a. $ _____________
the due date, not to exceed 50% of the amount of tax due)
6b. Interest
6b. $ _____________
(floating rate, see instructions)
Total Penalty and Interest
6. $ ____________________
(add lines 6a and 6b)
7.
Total Due with Return
7. $ ____________________
(add lines 5 and 6)
Overpayment Amount to be Credited* $________________ or Refunded $________________
*A credit memo will be issued by DOR. Credit may not be taken until the actual credit memo is received.
Under penalties of perjury, I declare that I have read the foregoing and the facts stated in it are true.
___________________________________________________________________________________________________
Signature of officer
Title
Phone number
Date
___________________________________________________________________________________________________
Signature of preparer
Address of preparer
Phone number
Date
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