Form 0405-331.1 - Alaska Oil And Gas Production Tax Credit Application For A Transferable Tax Credit Certificate Page 2

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State of Alaska
Alaska Oil and Gas Production Tax Credit
Department of Revenue
Application for a Transferable Tax Credit Certificate
Tax Division
550 W 7th Ave Ste 500
AS 43.55.023(d)
Anchorage AK 99501-3566
Phone 907.269.6620
Fax 907.269.6644
This form is available online at
DEPT USE ONLY
APP ID:
A. Producer or Explorer Name
Federal EIN
Date of Application
B. Producer or Explorer Tax Credit under AS 43.55.023(a) and AS 43.55.023(b)
Tax Year ________________
1. Enter total tax credit amount from Form 0405-330.2 ………………………………………………$
2. Enter total tax credit amount from Form 0405-330.3 ………………………………………………$
3. Enter total tax credit amount from Form 0405-330.8 ………………………………………………$
4. Total of Lines 1-3 ………………………………………………………………………………………$
5. Enter total tax credit from Lines 1-3 that was applied to tax liability ………………………………$
6. Remaining credit available for the year ……………………………………………………………… $
Tax Year ________________
1. Enter total tax credit amount from Form 0405-330.2 ………………………………………………$
2. Enter total tax credit amount from Form 0405-330.3 ………………………………………………$
3. Enter total tax credit amount from Form 0405-330.8 ………………………………………………$
4. Total of Lines 1-3 ………………………………………………………………………………………$
5. Enter total tax credit from Lines 1-3 that was applied to tax liability ………………………………$
6. Remaining credit available for the year ……………………………………………………………… $
Tax Year ________________
1. Enter total tax credit amount from Form 0405-330.2 ………………………………………………$
2. Enter total tax credit amount from Form 0405-330.3 ………………………………………………$
3. Enter total tax credit amount from Form 0405-330.8 ………………………………………………$
4. Total of Lines 1-3 ………………………………………………………………………………………$
5. Enter total tax credit from Lines 1-3 that was applied to tax liability ………………………………$
6. Remaining credit available for the year ……………………………………………………………… $
Remaining unused credit available for the year …………………………………………………… $
Total credit retained by producer or explorer for future tax liability ……………………………… $
Total credit for a Transferable Tax Credit Certificate ………………………………………… $
Note: To receive a Transferable Tax Credit Certificate a copy of all the forms included in this application must be attached.
I certify, under oath, that the expenditures for which the credit is claimed have been incurred, that the credit has not been
used, and that I am aware of no reason why I do not qualify for the credit.
Signature
Print Name and Title
Date
DEPT USE ONLY
Form 0405-331.1 web new 03/09 • page 1

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