Form Ap-134 - Crude Oil And Natural Gas Texas Tax Questionnaire - 2013

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AP-134
(Rev.1-07/13)
CRUDE OIL AND NATURAL GAS
00990
2 0
TEXAS TAX QUESTIONNAIRE
T Code
Tax type/Reason code
• PLEASE READ INSTRUCTIONS
• TYPE OR PRINT
• DO NOT WRITE IN SHADED AREAS
1. Legal name of owner
DBA (Operating name)
2. Mailing address
Phone (Area code & number)
City
State
ZIP Code
County
3. Comptroller taxpayer number
4. Federal Employer’s Identification number
5. Social Security number if sole owner
1
2
6. Do you now have a taxpayer number for reporting
Texas tax OR a Texas Vendor Identification number?
If yes, enter taxpayer number
YES
NO
If yes, enter taxpayer number
7. Are you a subsidiary or division of another company?
OR name
YES
NO
8. Type of ownership (Check one)
Sole owner
Partnership
Other (Explain)
Charter number
Charter date
Texas corporation
State
Charter number
Texas Certificate of Authority number
Date
Foreign corporation
(Non-Texas)
State
Identification number
Limited Partnership
9. Identification of owners: sole owner, all general partners or principal corporation officers (Attach additional sheets, if necessary.)
Name (First, middle initial, last)
Social Security number
Title
Home address (Street and number)
City
State
ZIP code
Name (First, middle initial, last)
Social Security number
Title
Home address (Street and number)
City
State
ZIP code
Name (First, middle initial, last)
Social Security number
Title
Home address (Street and number)
City
State
ZIP code
10. Check the type of reports you will file, and enter the month and year of your first sales and/or purchases.
Beginning year and month
Crude Oil Purchaser (Monthly)
Crude Oil Producer
Natural Gas Purchaser (Monthly)
Natural Gas Producer (Annual): Average monthly tax liability will be under $200/month or under $2400.00/year
Natural Gas Producer (Monthly): Average monthly tax liability will be over $200/month or over $2400.00/year
Natural Gas Cycling
SUCCESSOR LIABILITY: If you purchased an existing business or business assets, complete items 11-14. If you did not, skip to item 15.
11. Trade name
Taxpayer number
12. Legal name of former owner (First, middle initial, last)
Phone (Area code & number)
Former owner’s Texas taxpayer number (If known)
13. Address of former owner (Street & number, city, state & ZIP code)
14. Check each of the following items you purchased:
Inventory
Corporate Stock
Equipment
Real estate
Other assets
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