Form R-9036 - Gas Severance Tax Return Lease Detail G-1d
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R-9036 (7/10)
Gas Severance Tax Return
Lease Detail G-1d
Taxpayer Services Division
Page _______ of _______
Severance Taxes Section
P. O. Box 201
File original of this return only.
Baton Rouge, LA 70821-0201
PLEASE PRINT OR TYPE.
Reporting company name
Reporting company number
Revenue Account Number
This return is due by the 25th day of the second month following the taxable period and becomes
delinquent on the first day thereafter. If the due date falls on a weekend or holiday, the return is due
on the next business day and becomes delinquent on the first day thereafter. See special instructions
Reporting company address, city, state, ZIP
Taxable Period
(mm/dd/yyyy)
for additional filing requirements for taxpayers with liabilities equal to or in excess of $5,000. Report
all volumes in MCF (15.025 pounds absolute pressure and 60°F).
Gross gas
Field name
Conservation codes
Exclusions
Tax
production
Producer name
Taxpayer
rate
Net taxable MCF
Tax and interest
Lease and Well name
code
Plant
code
Parish
Field
Producer
Lease
MCF
Code
MCF
Code
MCF
Code
MCF
Plant name
code
Totals (to be entered on last page of return
if more than one page is used)
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