Form 8 - Oil And Gas Conservation Levy
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State
of Colorado
62088
FORM 8
Rev 10/22/01
Oil
and Gas Conservation
Commission
Page____of____
FOR OGCC USE ONLY
1120 Lincoln
Street,
Suite
801,
Denver,
CO 80203
(303)
894-2100
Fax:(303)
894-2109
OIL AND GAS CONSERVATION
LEVY
1. Mail all remittance to the COGCC, 1120 Lincoln Street, Suite 801, Denver, CO 80203
2. Only one quarter is to be reported per FORM 8. Adjustments and replacement reports for any quarter must be
filed on a separate Form 8 for each quarter to be adjusted or replaced.
3. Oil and gas revenues must be segregated; show product code Oil "O", Gas "G" or CO2 "C" for each line.
4. Exempted interests are: The United States of America "F", the State of Colorado "S", or any of its Political
Subdivisions "O", and any Indian or Indian Tribe "I" on production from land subject to the supervision of the
Receipt
Number:
United States.
5. Reason must be given for all exemptions taken and shall be entered on a separate line with operator name,
operator number, product type, exemption type, and exemption value.
6. Payment on market value should be calculated after exemptions are taken.
This return and remittance due on or before March 1, June 1, September 1,
and December 1 for the preceeding quarter of each year.
OGCC Payor Number:
Form Prepared By:
first
last
Name of Payor:
(
)
Address:
Phone Number:
(
)
City
State
Zip:
Fax Number:
:
:
This return covers oil and gas sold during quarter
of year
Assessed Mill Levy for Period:
First
Filing
Adjustment
Replacement
Total Sales for Period
Total Levy Due
Interest Due
Total Due
Operator
Pro-
Total Volume
Total Value Sold
Exempt Value in
Operator Name
Levy Due
Type
Number
duct
Sold in MCF or BBLS
in Dollars
Dollars
I, _________________________________________ am hereby authorized by _____________________________________________
to submit this report and do certify that to the best of my knowledge the information contained herein is correct.
/
/
)
(
Signature of Payor ________________________________ Phone No. ________ ___________________
_____
Date
(MM/DD/YYYY)
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