Form Sev.t-1s - Severance Tax - Timber - 2002 Page 2

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Reporting company name
Reporting company number
TIMBER
Reporting company address (Including ZIP)
SCHEDULE A
Report submitted during month of
Plant name
Plant location
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Column 7
Column 8
Parish
Product
Name of severer and/or purchaser
Taxable
Tons severed or
code
Name of timber tract or name source
code
Tax rate
Tax amount due
and complete address
purchased
Mo.
Yr.
number
number
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