Form Tc-684a - Severance Tax Annual Return - Schedule A Page 2
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1
2INSTRUCTIONS FOR SCHEDULE A
Complete a separate Schedule A for each Field.
Round all volumes and values.
Taxpayer Name and Address
13. Annual (Field) Exemption Percentage: Each line 12 adjusted value
Enter name and address of company submitting this report. Check
divided by the total adjusted value of Line 12 for each field.
appropriate box to indicate reporting as an Operator, Interest Owner,
First Purchaser or Other. If Operator box is checked, complete all
14. Annual (Field) Exemption: An annual exemption of the first $50,000
columns. If a box other than Operator is checked, complete all columns
in gross value of each well or wells is provided for each operator. The
except Transported and Reported by Others.
exemption is to be prorated among the interest owners in proportion to
their share of production or sales. The amount allocated to exempt
Utah Account Number
interest owners is the ratio of the exempt royalty value to the total value,
Enter the Utah account number of company submitting this report. This
multiplied by $50,000 on an annual basis. However, if any interest owner
number is assigned by the Utah Division of Oil, Gas and Mining.
takes products-in-kind and reports and pays the tax, that interest owner
is entitled to take a proportionate share of the exemption. The
Tax Year
proportionate share of the exemption is calculated by the operator for
Tax year covers one calendar year from 12:01 a.m. of first day to 12:00
the interest owner.
p.m. of last day. REPORT IS DUE on or before the first day of June
following the tax year.
15. Taxable Net Value Amount: Taxable net value amount equals
adjusted value, line 12, minus annual (field) exemption amount, line 14.
Field Number and Name
Enter number and name of field designated by the Field Names
16. Stripper Production Value: Enter net value of qualifying well or wells
Advisory Committee, Utah Division of Oil, Gas and Mining.
as defined under Utah Code 59-5-101 within the entity. Provide a
schedule by API number showing qualifying production and value. Do
Amended Report
not include any amounts previously deducted as exempt royalties (line
Check the amended report box if this report is changing or updating
11) or annual exemption (line 14).
information previously submitted.
17. First Six (6) Months Development Well Value: Enter net value of
1. Amended (+-): Use this line only when an amended report is filed.
production from qualifying development well or wells within the entity.
Amended reports include only specific product and pricing entity being
Provide a schedule by API number showing qualifying production and
corrected. Report should contain the following: Original Entry: Enter a
value. An exemption from the payment of severance tax is allowed for a
minus (-) to indicate original entry being deleted. Entry should be written
period of six months following the first day of production. Do not include
as it appeared on original return. Corrected Entry: Use a plus (+) on
any amount previously deducted as exempt royalties (line 11) or annual
second column to indicate corrected entry.
exemption (line 14).
2. Producing Entity Number: Enter number assigned to producing entity
18. First Twelve (12) Months Wildcat Well Value: Enter net value of
by Utah Division of Oil, Gas and Mining.
production from qualifying wildcat well or wells as defined under Utah
Code 59-5-101 within the entity. Provide a schedule by API number
3. Product Type: Enter one of the following codes for product type: OL-
showing qualifying production and value. An exemption from the
Oil; GS-Gas; NL-Natural Gas Liquids
payment of severance tax is allowed for a period of twelve months
following the first day of production. Do not include any amount
4. Transported: Entries on this line should be made only by the operator.
previously deducted as exempt royalties (line 11) or annual exemption
Enter quantity of product produced, saved, and sold or transported from
(line 14).
producing entity.
19. Taxable Amount: Taxable amount equals taxable net value amount,
5. Reported by Others: Enter volume of product taken-in-kind by another
line 15, minus the value attributable to stripper, line 16, first six months,
party. If entry is made on this line, form TC-806 should be submitted.
line 17, and first twelve months, line 18, production exemptions.
6. Subject to Tax: Volume subject to tax equals volume transported
20. Oil & Gas Taxable Value at 3%: 3% of the value up to and including
minus reported by others, line 5.
the first $13 per barrel for oil. 3% of the value up to and including the
first $1.50 per mcf for gas.
7. Gross Product Value: Gross product value is value determined for
volume subject to tax before deductions.
21. Oil & Gas Taxable Value at 5%: 5% of the value from $13.01 and
above per barrel for oil. 5% of the value from $1.51 and above per mcf
8. Processing deduction: Enter the amount of processing costs, as
for gas.
defined by Utah Code 59-5-101, allowable as a deduction from the
gross product value. A schedule with a detailed breakdown of these
22. NGL taxable at 4%: The severance tax rate for natural gas liquids is
costs taken as a deduction, must be provided.
4% of the taxable value for natural gas liquids.
9. Transportation deduction: Enter the amount of transportation costs, as
23. Incremental Tax Value: A 50% reduction in the tax rate is imposed
defined by Utah Code 59-5-101, allowable as a deduction from the
upon the "Incremental production" achieved from an "Enhanced
gross product value. A schedule with a detailed breakdown of these
recovery project," as defined by Utah Code 59-5-101. Provide a
costs taken as a deduction, must be provided.
schedule showing the amount of incremental production volume and
value.
10. Net Product Value: Net product value equals gross product value
minus processing and transportation deductions.
Field Total: Enter the field totals for lines 7 through 23 on the last page
of the Schedule A used for each field.
11. Exempt Royalties: Deduct the amount of royalties equal to the
percentage of exempt royalty interest attributable to the United States,
Grand Total: Enter on the last Schedule A used the Grand Total of all
State of Utah, Bureau of Indian Affairs and/or Indian Tribe.
field totals.
12. Adjusted Value: Adjusted value equals net product value minus
exempt royalties.
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