Form Sev. O-1d - Oil And/or Condensate Severance Tax Return - Lease Detail
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1FORM SEV. O-1d
State of Louisiana
R-9015-L (12/03)
Department of Revenue
P. O. Box 201, Baton Rouge, LA 70821-0201
Page
of
OIL AND/OR CONDENSATE SEVERANCE TAX RETURN - LEASE DETAIL
File original of this return
Reporting company name
Revenue account number
This return is due on or before the last day of the month following the taxable period and becom
delinquent the first day thereafter. If due date falls on a weekend or holiday, the return is due on the f
business day following the due date and becomes delinquent the first day thereafter. See spe
Reporting company address (Including ZIP code)
Reporting company number
Taxable Period
instructions for additional filing requirements for taxpayers with liabilities equal to or in excess
$ 1 5 , 0 0 0 .
Less barge
Total tax,
Field name
Conservation Codes
Codes
Gross
pipeline or
Net
penalty ,
Producer name
taxable
truck
taxable
and interest
Lease name
value
charge
value
Schedule
due
Tax
Purchaser name
amount
amount
code
amount
Field
Producer
Barrels
amount
Parish
Lease
Purchaser
Kind
rate
$
$
$
$
TOTALS
(To be entered
on last page of
$
$
$
$
return)
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