Form Mt-07 - Initial Oil Or Gas Exemption Request

Download a blank fillable Form Mt-07 - Initial Oil Or Gas Exemption Request in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Mt-07 - Initial Oil Or Gas Exemption Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

KANSAS DEPARTMENT OF REVENUE
DIVISION OF TAX OPERATIONS
MINERAL TAX
TOPEKA KS 66625-0918
PHONE: 785-296-7713
FAX: 785-296-4993
INITIAL OIL OR GAS EXEMPTION REQUEST
Application is hereby made to the Director of Taxation to exempt the following lease or well from Kansas Mineral Tax. Application is made with full
knowledge of the penalties as prescribed by law. See instructions on back of this form. Return completed form to the address above.
OFFICE USE ONLY EXEMPTION STATUS
New Operator Name and Address
Exemption Approved: ____ Yes ____ No
Approved Exemption No.: ________________
Effective Date: _________________________
Termination Date: ______________________
Contact Information
LEASE INFORMATION (MANDATORY FOR ALL EXEMPTIONS)
Reason for Exemption (check only one): ____ Minimum Production
____ Water Flood
____New Pool
KCC Operator I.D. Number: __________________________
Operator Phone Number:___________________________ API Number: ________________
If Oil Well, Kansas Oil Lease / Well Number: _1_ ___ ___ ___ ___ ___. If Gas Well, Kansas Gas Lease / Well Number: _2_ ___ ___ ___ ___ ___
Lease Name: ___________________________________________ County Name: _______________________________________________
Legal description: Sec. _______________ Twn. ________________ Rng _______________ Average Depth of Producing Wells: _______________
Number of Producing wells on Lease (Injection wells are not counted as producing wells: __________
Name of Producing Formation:_______________________________________________ Field Name: _______________________________________
COMPLETE IF WATER FLOOD OR MINIMUM PRODUCTION EXEMPTION
Average Daily Production is __________ BOPD. This is for the most recent six month period beginning __________________ and ending _________________.
See back of this form for more detail in calculating average daily production and current exemption levels.
Do not send this form in if Average Daily Production is above the minimum levels.
If Water Flood Exemption, is production gauged separately? ___ Yes ___ No
If Water Flood Exemption, what is the docket number from the LCC Enhanced Recovery Order? ___________________________________________________
COMPLETE IF NEW POOL EXEMPTION
What is the Docket Number issued by the KCC? _______________________________
The New Pool exemption is valid for 2 years from the KCC certified date of first production. KCC certified date is: ______________________________
Is New Pool production commingled? ___ Yes ___ No If yes, indicate: ___ Downhole ___ In Tank ___ At Meter
COMPLETE IF INCREMENTAL OR EXEMPTION
The KCC must certify all enhancement projects prior to exemptions being granted. Incremental Exemptions are granted on a well basis only.
If Incremental Exemption, what is the certified KCC enhancement project number? _____________________________________
The Incremental Exemption is valid for 7 years form the KCC certified startup date. KCC certified date is: ___________________________
I declare under the penalties of perjury that all the required KCC certifications have been received and this application is true and correct.
New Pools are required to submit a
Signature of Authorized Officer or Agent
Date
copy of the KCC Certification letter
with this form.
Purchaser Nane and Address Information
Purchaser ID #
Print Operator’s & Purchaser’s address
clearly, they will be used as mailing
Contact Information
labels.
MT-07
(Rev. 6/11)
OPERATOR’S COPY
DEPARTMENT’S COPY
PURCHASER’S COPY

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2