Form 320-C - Gross Production Request For Change - 2011
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1
2Form 320-C
Gross Production Request for Change
Revised 6-2011
Oklahoma Tax Commission
Post Office Box 26920, Oklahoma City, OK 73126-0920
(Please read instructions before completing and print or type information)
Go to for Gross Production Tax Rates
Part 1: Operator Information
For Office Use Only
Incentive Code: ____________________________
A. Check one box:
Operator
Interest Owner
Qualifying Date: ___________________________
B.
FEIN/SSN ___________________________________________________
County
Lease
Sub
Merge
C.
Operator Number/Interest Owner _________________________________
Number
Number
Number
Number
%
D.
Name of Operator/Interest Owner _________________________________
E. Mailing Address _______________________________________________
Exempt
Decimal
F.
City ________________________________ State _______ Zip _________
Code
Equivalent
Business
G.
H.
Is this a new address? Yes
No
Telephone ________________
Part 2: Production Unit Number/Well Name
A.
B.
_________________________
Lease Name ____________________________________________________________
Production Unit Number
C.
Well Name/Number _____________________________________________________________________________________
D. Check appropriate box below and complete Part 4.
1.
Cancel product code(s)
2.
Cancel production unit number (explain in reasons below, Part 5, Section B)
3.
Change of operator - is this a change of ownership of equipment?
Yes
No Complete Parts 3 and 4
4.
Cancel or add purchaser
5.
Change of producing formation/legal description
E.
Name of formation/spacing order __________________________________________________________________________
F.
Lease legal description __________________________________________________________________________________
Part 3:
A.
B.
C.
_____________________________________________
______________________
____________________
Name of Former Operator
Former Operator Number
Effective Date of Change
Part 4: Product and Purchaser Change Information
(Obtain product code number from general instructions or specific instructions on page 2 and list purchasers you will be selling to)
A.
B.
C.
D.
E.
F.
G.
Date
Tax Remitter
Effective
Prod.
Purchaser
Interest
Mo. Year
Add
Cancel
Purchaser
Operator
Code
Purchaser Name
Number
Owner
Part 5:
A. If operator or interest owner requests to remit production taxes, please provide reason:
_____________________________________________________________________________________________________________
B. Reasons for cancel or suspension _________________________________________________ C. Effective Date: _____________
D. Comments: ________________________________________________________________________________________________
Part 6: For Office Use Only
Request for operator/interest owner to remit taxes is
Approved
Denied
By _________________ Date _____________
Part 7:
I declare under penalty of perjury that to the best of my knowledge the above information is true and correct.
____________________________________________________
____________________________________ _______________
Type or print name and title
Signature
Date
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