Form R-9023 - Oil And/or Condensate Severance Tax Return

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O-1s
Page
of
FORM SEV.
R-9023 (1/97)
State of Louisiana
Reporting company name
Reporting company number
Department of Revenue and Taxation
P. O. Box 144, Baton Rouge, LA 70821-0144
Street or P.O. address
Report submitted during month of
OIL AND/OR CONDENSATE SEVERANCE TAX RETURN
Revenue Account Number
City, state, ZIP
PARISH SUMMARY
Taxable
Tax
Par.
Taxable
Tax, penalty, and
period
rate
Under the penalties of perjury, I declare that I have examined this return, including all
Parish name
code
barrels
interest amount
code
Month
Year
accompanying documents, and to the best of my knowledge and belief, it is true, correct, and
complete.
.
$
.
I understand that the information reported on this return will be used in the administration and
enforcement of the Severance Tax laws, rules and regulations, and may be disclosed to other
.
$
.
parties involved in these reported transactions.
.
$
.
Name and Title (Print or type.) __________________________________________________
.
$
.
Signature __________________________________________________________________
.
$
.
Date ______________________________________________________________________
.
$
.
(
)
Telephone __________________________________________________________________
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$
.
This return is due on or before the last day of the 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 first business day after the due date and becomes delinquent on the first day
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$
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thereafter.
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FILE ORIGINAL OF THIS RETURN ONLY.
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Section below to be completed on the last sheet of SEV. O-1’s only-See reverse side for instructions.
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$
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Tax rate
Summary
Total barrels
Total tax & interest amount
% of Value
.
$
.
12.5%
Totals, Full Rate-Oil & Condensate
1
.
$
.
.
$
.
6.25%
Totals, Half Rate-Incapable Oil
2
.
.
.
$
.
3.125%
Totals, Quarter Rate-Stripper Oil
3
.
.
.
$
.
3.125%
Totals, Reclaimed Oil
9
.
.
.
$
.
TOTAL INTEREST & PENALTY
6
N/A
.
.
.
$
.
GRAND TOTAL
N/A
N/A
.
$
.
.
$
.

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