Form 10-143-Texas Report Of Natural Gas
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1
2Comptroller
TEXAS REPORT OF NATURAL GAS
O I
10-143
of Public
Accounts
FORM
(Rev. 9-01/ 21)
PUR/PROC
11100
a. T Code
Do not write in the space above
PRODUCER
11200
Page 1 of
00990
1124
c. Taxpayer number
d. Filing period
e. (yymm)
REPORT MUST BE FILED
EVEN IF NO TAX IS DUE
f.
Taxpayer name and mailing address
g. Due date of this report
• USE DOLLARS AND CENTS WHERE APPLICABLE
• DO NOT TYPE IN SHADED AREAS
• SEE INSTRUCTIONS ON REVERSE SIDE
h.
i.
PLEASE TYPE
NOTE: If Item 13 for any lease is "NO," DO NOT complete Items 14, 15 and 16 for that lease.
OIL FIELD CLEAN–UP REGULATORY FEE
4A. Commodity
5A.
6A.
7A.
8A.
9A.
10A. Gross taxable fee volume
8
0
000
000000
0
00000000000
FE
X
0
11A. Net taxable fee volume 12A. Amount of fee due
13A.
14A.
15A.
16A.
000
000
000
X
0
1. Lease name ( as recorded with the Texas Railroad Commission )
2. County of production
3. Other party name
4. Commodity
5. Type
6. County code
7. Lease no./Self–check digit
8. Other party number
9. Are you the lease operator?
10. Total lease vol/tax rate
YES 1
NO 0
11. Your volume
12. Value of your volume
13. Are you liable for tax?
14. Exempt value
15. Marketing costs
16. Net taxable value/tax due
YES 1
NO 0
1. Lease name ( as recorded with the Texas Railroad Commission )
2. County of production
3. Other party name
5. Type
6. County code
7. Lease no./Self–check digit
8. Other party number
9. Are you the lease operator?
10. Total lease vol/tax rate
4. Commodity
YES 1
NO
0
11. Your volume
12. Value of your volume
13. Are you liable for tax?
14. Exempt value
15. Marketing costs
16. Net taxable value/tax due
YES 1
NO
0
j. T Code
PUR/PROC
11110
PRODUCER
11210
REPORT TOTALS AND TAX COMPUTATION
PLEASE TYPE
17. Total net taxable
value of condensate
18. Total net taxable
value of gas
19. Tax due on condensate
24. Total tax and fee due
( Item 19 plus Item 23 )
( Multiply Item 17 by
)
25. Enter overpayments ( Attach
20. Tax due on gas
“Transfer of Previous Payment” )
( Multiply Item 18 by
)
21. Regulatory fee due
26. Net amount due
( Multiply Item 11A by
)
( Item 24 minus Item 25 )
27. Late filing penalty and
interest ( See instructions )
22. Tax due on type 5 leases
23. Amount of tax & fee due on gas
28. TOTAL AMOUNT DUE AND PAYABLE
( Total of Items 20, 21 and 22 )
( Item 26 plus Item 27 )
I declare that the information in this document and any attachments is true
Make the amount in Item 28 payable to:
Field Office no.
and correct to the best of my knowledge and belief.
STATE COMPTROLLER
sign
Taxpayer or duly authorized agent
Date
here
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
111 E. 17th Street
E.O. name
Destin.
Austin, TX 78774-0100
Phone ( Area code and number )
Date
For assistance with any Texas Natural Gas Tax problem, call 1-800-252-1384 toll free nationwide. The Austin number is 512-463-4600.
(From a Telecommunication Device for the Deaf (TDD) ONLY call 1-800-248-4099 toll free. The Austin number is 512-463-4621.)
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