Form 62a384-G - Natural Gas Property Tax Return - 2011
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262A384-G (1-11)
File with:
NATURAL GAS
Department of Revenue
Commonwealth of Kentucky
PROPERTY TAX RETURN
Station 33
DEPARTMENT OF REVENUE
501 High Street
Frankfort, Kentucky 40620
(502) 564-8334
Property Assessed January 1, ________
Name
Number and Street
Social Security Number
City
State ZIP Code
Telephone Number
Federal Identification Number
(
)
INSTRUCTIONS: Under Kentucky law (KRS 132.820) each property owner is required to report all taxable property which
he or she owns. This includes sub-surface mineral rights which are taxable as an interest in real property. This return is provided
for the purpose of reporting developed gas property. Each year all persons, corporations, businesses and partnerships owning,
leasing or having knowledge of developed gas properties in the Commonwealth of Kentucky must complete and file this tax
return with the Office of Property Valuation by April 15. File a separate return for each developed property per county. If the
division of ownership is different for each well on the property, file a separate tax return for each individual well.
DEVELOPED PROPERTY
Property located in _________________________________________________ County, Kentucky.
Year of First Production ________________
Lease Number Assigned by Purchaser _______________________________________________________________________________
Property Name and Well Number ___________________________________________________________________________________
Total Gas Production (January 1–December 31) _________________________________________________________________(MCFs)
Number of Producing Wells _______________________________________________________________________________________
Purchaser Name(s) ______________________________________________________________________________________________
Operator’s Name ________________________________________________________________________________________________
Total Dollar Value of Well Production (Less Severance Tax) $ ___________________________________________________________
Division of Ownership (See Reverse Schedule)
DECLARATION
I declare, under the penalties of perjury, that this return (including any accompanying schedules and statements) has been examined by me
and to the best of my knowledge and belief is a true, correct and complete return; and that my taxable property has been listed at its fair
cash value.
_____________________________________________
_______________________________________________
Name of Company
Signature of Preparer
_____________________________________________
_______________________________________________
Signature of Producer/Operator
Date
Filings received after April 15 will be treated as omitted with applicable penalties applied.
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