Severance Tax Report Gas Form
ADVERTISEMENT
16WDWH RI :\RPLQJ
3000
SEVERANCE TAX REPORT
'HSDUWPHQW RI 5HYHQXH
:HVW WK 6WUHHW
GAS
&KH\HQQH :<
DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
O - Original
Form Type:
Taxpayer Name:
A - Amended
Contact Name:
Contact Phone Number:
352'8&7,21
5(3257,1*
5$7(
*5266 6$/(6
*5266 6$/(6
(;(037 52<$/7<
7$;$%/(
727$/ 7$; '8(
3(5,2'
*5283
&2'(
92/80(
9$/8(
352&(66,1* $1'
9$/8(
PP\\\\
180%(5
75$163257$7,21
NOTE: For amended returns (Form
1
Type ‘A’) report REPLACEMENT
VALUES ONLY.
2
3
NOTE: A change in Rate Code
4
requires BOTH an amended report for
for the originally reported rate code
5
and an original report for the
new rate code.
6
7
NOTE: For amendments Total Tax
8
Due is the replacement amount and
will not reflect previous tax applied to
9
your account. Be sure to account
for tax previously applied to your
10
account prior to remitting the current
payment.
11
12
PAGE TOTAL:
MTSII 10/8/01
I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete.
Authorized Signature
Title
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial