Form 300-C - Gross Production And Petroleum Excise Tax Remittance

Form 300-C - Gross Production And Petroleum Excise Tax Remittance - 2011

GPX

0400400

GPX0004-6-11

Form 300-C

Oklahoma Tax Commission

Revised 6-2011

Gross Production and Petroleum

Excise Tax Remittance Form

-Office Use Only-

A. Taxpayer FEIN/SSN

B. Company Reporting Number

C. Reporting Period

D. Check/Voucher

- - - - - - - - - - - - - - - Dollars - - - - - - - - - - - - - - -

- Cents -

1. Oil Gross Production Tax @ 1% Tax Rate .......................... _________________________________ . _______

2. Oil Gross Production Tax @ 4% Tax Rate .......................... _________________________________ . _______

3. Oil Gross Production Tax @ 7% Tax Rate .......................... _________________________________ . _______

4. Total Gross Production Tax Paid on Oil .......................... _________________________________ . _______

5. Oil Petroleum Excise Tax @ 0.095% Rate .......................... _________________________________ . _______

6. Gas Gross Production Tax @ 1% Tax Rate ........................ _________________________________ . _______

7. Gas Gross Production Tax @ 4% Tax Rate ........................ _________________________________ . _______

8. Gas Gross Production Tax @ 7% Tax Rate ........................ _________________________________ . _______

9. Total Gross Production Tax Paid on Gas ........................ _________________________________ . _______

10. Gas Petroleum Excise Tax @ 0.095% Rate ....................... _________________________________ . _______

11. Total Gross Production Tax ............................................. _________________________________ . _______

12. Total Petroleum Excise Tax .............................................. _________________________________ . _______

13. Total Amount Paid ............................................................. _________________________________ . _______

E. Company Name and Address:

I declare that the information contained in this document and any attachments is true and correct to the best of my knowledge and belief.

Sign Here: _______________________________________________________

Date: _____________________________

Print Name: ______________________________________________________

Phone: ____________________________

Form 300-C - Gross Production And Petroleum Excise Tax Remittance - 2011