Form Mts2 - Severance Tax Schedule Oil Well Incentive Reporting 2002
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1SEVERANCE TAX SCHEDULE
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Oil Well Incentive Reporting
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DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
Taxpayer Name:
API NUMBER
352'8&7,21
5(3257,1*
5$7(
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6,'(75$&.
5(6(592,5
3(5,2'
*5283
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180%(5
180%(5
180%(5
180%(5
*5266 6$/(6 92/80(
*5266 6$/(6 9$/8(
7$;$%/( 9$/8(
PP\\\\
180%(5
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I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete.
Authorized Signature
Title
Date
MTS2 12/16/99
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