Form Tc-5 - Amended Report - 2003 Page 2
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1
2INSTRUCTIONS
UTAH ACCOUNT NUMBER
Transported:
Enter quantity of product produced and
Enter Utah account number of the company submitting
saved, sold or transported from producing entity.
this report. Number is assigned by Utah Division of
Reported by Other:
Enter volume of product taken-
Oil, Gas and Mining.
in-kind by another party. If entry is made in this column,
REPORT PERIOD
Form TC-806 should be submitted.
Report period covers one calendar quarter.
Volume Subject To Fee:
Volume subject to fee equals volume
The due dates for these reports are:
transported minus reported by others.
1st QTR: Jan 1 - Mar 31 due on or before June 1
Product Value:
2nd QTR: Apr 1 - Jun 30 due on or before September 1
Product value is value determined from
3rd QTR: Jul 1 - Sep 30 due on or before December 1
volume subject to fee before exempt royalty deductions.
4th QTR: Oct 1 - Dec 31 due on or before March 1
State Royalties:
Royalties paid to State of Utah or
of next year
political subdivisions from producing entity.
ACCOUNT NAME
Indian Royalties:
Royalties paid to Bureau of Indian
Enter name of company submitting this report.
Affairs or Indian tribe from producing entity.
Check appropriate boxes to indicate whether reporting
Federal Royalties:
Royalties paid to United States of
as Operator or Other.
America or political subdivisions from producing entity.
AMENDED REPORT
Value Subject To Fee:
Value amount equals product value
Check box if this report is changing or updating
minus State, Indian and Federal royalities.
information previously submitted.
TOTAL Value Subject To Fee:
Total of values shown
Amended(+-):
This column is to be used only when an
in the "Value Subject To Fee" column.
amended report is filed. Amended reports include
only specific product and producing entity being
FEE DUE:
Multiply total value amount by .002.
corrected. Report should contain the following:
GRAND TOTAL:
Enter grand total of fee due on
Original Entry-
Use a minus(-) on first line to indicate
last page of return only.
original entry being deleted. Entry should be written
Preparer should sign report and enter the date and
as it appeared on original return.
telephone number at bottom. Mail report and any
Corrected Entry-
Use a plus(+) on second line to
remittance to:
indicate corrected entry.
Utah State Tax Commission
210 North 1950 West
Producing Entity No.:
Enter number assigned to
Salt Lake City, UT 84134
producing entity by Utah Division of Oil, Gas
and Mining.
For additional information, contact the Utah State Tax
Commission, telephone (801) 297-2200 or go to our
Product Type:
Enter one of the following codes for product
website at tax.utah.gov.
type: OL-Oil; GS-Gas; NL-Natural Gas Liquids.
FORM TXOGF4 6/03
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