Form R-9003-L - Monthly Incapable And Stripper Oil Well Report

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Page ________ of ________
State of Louisiana
R-9003-L (12/03)
File original of this return only.
Department of Revenue
0-3
FORM SEV
P.O. Box 201
Oil Severance Tax
Baton Rouge, LA 70821-0201
Monthly Incapable and Stripper Oil Well Report
Reporting company name
Revenue Account Number
Reporting company address (including ZIP code)
Reporting Company Number
Taxable Period
Conservation codes
No.
Field name
Conservation
Cert.
Parish
Production
Average
Disposition
Taxpayer
Cont.
of
Producer name
code
well serial no.
code
prod.
daily prod.
status
(barrels)
(barrels)
number
Lease and well name
Field
Producer
Lease
Well no.
days
code
This report is due on or before the fifteenth 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.

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