Form Sev. O-1d - Oil And/or Condensate Severance Tax Return - Lease Detail
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1
2FORM SEV. O-1d
R-9015-L (1/06)
OIL AND/OR CONDENSATE SEVERANCE TAX RETURN - LEASE DETAIL
P. O. Box 201, Baton Rouge, LA 70821-020
Page__________ of__________
File original of this return only.
Reporting company name
Revenue account number
This return is due on or before the twenty-fifth day of the second month following the taxable period and
becomes delinquent the first day thereafter. If due date falls on a weekend or holiday, the return is due on
Reporting company address (Including ZIP code)
Reporting company number
Taxable Period
the first business day following the due date and becomes delinquent the first day thereafter.
Field name
Conservation Codes
Codes
Producer name
Gross taxable
Less barge pipeline or
Net taxable value
Total tax, penalty, and
Schedule
Barrels
Lease name
value amount
truck charge amount
amount
code
interest due amount
Tax
Parish
Field
Producer
Lease
Purchaser
Kind
Purchaser name
rate
$
$
$
$
TOTALS (To be entered on last page of return)
$
$
$
$
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