Fillable Form R-9037 (7/07) - Gas -Parish Summary Return printable pdf download

Form R-9037 (7/07) - Gas -Parish Summary Return

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R-9037 (7/07)

If your name has

If your address has

If amended return,

If final return,

changed, mark circle.

mark circle.

Account ID (10 digit BMF #)

Gas-Parish Summary

Name

Return (G1-S)

Address 1

Address 2

Louisiana Department of Revenue

P. O. Box 201

Address 3

Baton Rouge, LA 70821-0201

(225) 219-7656 (225) 219-2114 (TDD)

Reporting Company ID (5 digit Severance #)

FOR OFFICE USE ONLY.

F i e l d f l a g

Taxable

period

Tax

Tax rate per

Summary

Rate

Total Taxable MCF

Tax Amount Due

MCF

Code

Full rate – capable gas

$ 0.269

Incapable rate – oil well gas

$ 0.03

Incapable rate – gas well gas

$ 0.013

Produced Water Injection Incentive – Approved Projects Only

Produced water – Full rate

$ 0.215

Produced water – incapable rate-oil well gas

$ 0.024

Produced water – incapable rate-gas well gas

$ 0.0104

Penalty and Interest

GRAND TOTAL

Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and belief, it is true,

correct, and complete. If the return is prepared by a person other than the taxpayer, his declaration is based on all the information relating to the matters required to be

reported in the return of which he has any knowledge.

Date

Signature

Signature of preparer other than taxpayer

Preparer ID

Telephone Number

This return is due on or before the 25th day of the second month following the taxable period and becomes delinquent on the first day thereafter. If the due

date falls on a weekend or holiday, the return is due the next business day and becomes delinquent the first day thereafter. See special instructions for

additional filing requirements for taxpayers with liabilities equal to or in excess of $ 10,000.

Complete only if change in business status has occurred. Please print or type.

Date business discontinued

Date business sold

Name of purchaser

5406