Form R-9054-L - Monthly Oil Well Report For Exempt Wells - 1997

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R-9054-L (11/97)
State of Louisiana
O-5
FORM SEV
Department of Revenue
Page _________ of ________
Oil Severance Tax
P. O. Box 201, Baton Rouge, Louisiana 70821-0201
File original of this return only.
Monthly oil well report for exempt wells
Reporting company name
Reporting company number
Report submitted during month of
Reporting company address (including ZIP code)
Revenue Account Number
Taxable
Value for payout
Conservation codes
Field name
period
Conservation
Parish
Production
Disposition
of well cost
Taxpayer
Producer name
well serial no.
code
(barrels)
(barrels)
(disposition barrels)
number
Lease and Well name
Field
Producer
Lease
Mo. Yr.
This report must be filed with Form R-9015 (O-1d), Oil and/or Condensate Severance Tax Return – Lease Detail.

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