Form Tc-5 - Utah Quarterly Oil And Gas Conservation Oil Fee Return, Tc-5 Page 2
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1
2INSTRUCTIONS
Volume Subject To Fee:
UTAH ACCOUNT NUMBER
Volume subject to fee equals volume
transported minus reported by others.
Enter Utah account number of the company submitting
this report. Number is assigned by Utah Division of
Product Value:
Product value is value of volume subject to fee
Oil, Gas and Mining.
before any deductions.
REPORT PERIOD
Processing/Transportation Deduction:
Enter the amount
Report period covers one calendar quarter.
of processing and transportation costs, as defined by
The due dates for these reports are:
Utah Code 59-5-101, allowable as a deduction from
1st QTR: Jan 1 - Mar 31 due on or before June 1
product value. A schedule with a detailed breakdown of
2nd QTR: Apr 1 - Jun 30 due on or before September 1
these costs taken as a deduction, must be provided.
3rd QTR: Jul 1 - Sep 30 due on or before December 1
4th QTR: Oct 1 - Dec 31 due on or before March 1
of next year
Adjusted Product Value:
Subtract processing/transportation
deduction from product value.
ACCOUNT NAME
Enter name of company submitting this report.
State Royalties:
Deduct the amount of royalties equal to the
percentage of exempt royalty interest attributable to the state
Check appropriate boxes to indicate whether reporting
or political subdivision of the state from the producing entity.
as Operator or Other.
Indian Royalties:
Deduct the amount of royalties equal to the
AMENDED REPORT
percentage of exempt royalty interest attributable to an Indian
Check box if this report is changing or updating
or Indian Tribe for lands subject to the supervision of the
information previously submitted.
United States from producing entity.
Amended(+-):
This column is to be used only when an
Federal Royalties:
Deduct the amount of royalties equal to the
amended report is filed. Amended reports include
percentage of exempt royalty interest attributable to the United
only specific product and producing entity being
States from the producing entity.
corrected. Report should contain the following:
Value Subject To Fee:
Value amount equals adjusted product
Original Entry-
Use a minus(-) on first line to indicate
value minus State, Indian and Federal royalties.
original entry being deleted. Entry should be written
as it appeared on original return.
TOTAL Value Subject To Fee:
Total of values shown
in the "Value Subject To Fee" column.
Corrected Entry-
Use a plus(+) on second line to
indicate corrected entry.
FEE DUE:
Multiply total value amount by .002.
Producing Entity Number:
Enter number assigned to
GRAND TOTAL:
Enter grand total of fee due on
producing entity by Utah Division of Oil, Gas
last page of return only.
and Mining.
Preparer should sign report and enter the date and
Product Type:
Enter one of the following codes for product
telephone number at bottom. Mail report and any
type: OL-Oil; GS-Gas; NL-Natural Gas Liquids.
remittance to:
Utah State Tax Commission
Transported:
Enter quantity of product produced, saved,
210 North 1950 West
sold or transported from producing entity.
Salt Lake City, UT 84134
Reported by Other:
Enter volume of product taken-
For additional information, contact the Utah State Tax
in-kind by another party. If entry is made in this column,
Commission, telephone (801) 297-2200 or go to our
Form TC-806 should be submitted.
website at tax.utah.gov.
FORM TXOGF4 4/04
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