North Dakota Oil Producers Report And Oil Purchasers Report Instructions Sheet Page 22
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23AMENDED RETURN EXHIBIT
ABC OIL COMPANY
North Dakota Producer's Statement of Oil Production
T-10 Worksheet - Oil
Producer's Name
Gross Production & Oil Extraction Tax
123456789
Federal I.D. No.
(Revised July 1996)
Page
1 of
4
9606
MCKENZIE
County
For instruction booklet or forms call the Office of State Tax Commissioner: 701-328-3593.
YEAR MONTH
(Only one county per worksheet)
Persons who have impaired hearing or speech may call our TDD number: 701-328-2778.
GROSS PRODUCTION TAX
OIL EXTRACTION TAX
Barrels of Oil
Barrels of
Posted
Average
Value of
Value of Exempt
Taxable Value of Oil
No. of
Well
Taxable Value of Oil
Purchaser's Name(s)
Produced
Oil Sold
Price Per
Price Per
Oil Sold
Government
(Block 2 minus Block 3)
Wells in
Code
(See Instructions)
(Round to two places) (Round to two places)
Barrel
Barrel
Royalties
Property
A
1
1a
1b
2
3
4
B
C
8
(100.00) 15.50
15.25
(1,525.00)
(95.31)
(1,429.69)
1 NW
(1,429.69)
ACME OIL COMPANY
API Number
T/C
Pool Code
Total Production Tax Due
Total Extraction Tax Due
5
9
33 --
053-1234
40
(71.48)
(57.19)
(5% of Block 4)
(4% or 6.5% of Block 8)
Well or Lease Name
Production Tax
Extraction Tax
6
10
JOHN DOE 1-10
Paid by others
Paid by others
Field
Pool
Production Tax Paid with
Extraction Tax Paid with
7
11
ROUGHRIDER
MADISON
(71.48)
(57.19)
Report (blk 5 - blk 6)
Report (blk 9 - blk 10)
A
1
1a
1b
2
3
4
B
C
8
95.00
15.50
15.25
1,448.75
86.93
1,361.82
1 S1
ACME OIL COMPANY
API Number
T/C
Pool Code
Total Production Tax Due
5
Total Extraction Tax Due
9
33 --
053-1234
40
68.09
(5% of Block 4)
(4% or 6.5% of Block 8)
Well or Lease Name
Production Tax
Extraction Tax
6
10
JOHN DOE 1-10
Paid by others
Paid by others
Field
Pool
Production Tax Paid with
Extraction Tax Paid with
7
11
ROUGHRIDER
MADISON
68.09
Report (blk 5 - blk 6)
Report (blk 9 - blk 10)
A
1
1a
1b
2
3
4
B
C
8
API Number
T/C
Pool Code
Total Production Tax Due
Total Extraction Tax Due
5
9
33 --
(5% of Block 4)
(4% or 6.5% of Block 8)
Well or Lease Name
Production Tax
Extraction Tax
6
10
Paid by others
Paid by others
Field
Pool
Production Tax Paid with
Extraction Tax Paid with
7
11
Report (blk 5 - blk 6)
Report (blk 9 - blk 10)
A
1
1a
1b
2
3
4
B
C
8
API Number
T/C
Pool Code
Total Production Tax Due
5
Total Extraction Tax Due
9.00
33 --
(5% of Block 4)
(4% or 6.5% of Block 8)
Well or Lease Name
Production Tax
Extraction Tax
6
10.00
Paid by others
Paid by others
Field
Pool
Production Tax Paid with
Extraction Tax Paid with
7.00
11.00
Report (blk 5 - blk 6)
Report (blk 9 - blk 10)
(3.39)
(57.19)
Page Total - Blocks 7
Page Total - Blocks 11
Cumulative
(3.39)
(57.19)
Cumulative Total for County
Total for County
If final page for county, carry totals to T-10A (County Summary)
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