Instructions For Form R-9001-L - Application For Certification Of Incapable Wells

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R-9001 I (2/04)
Instructions
This application form is to be completed in its entirety by the producer, taxpayer, or other authorized agent of the
severer. The original and one (1) copy are to be submitted to the Department of Revenue, P.O. Box 4998, Baton
Rouge, Louisiana 70821 on or before the 15th of the second month following the production month in which the
reduced tax rate(s) is applicable. If the due date falls on a weekend or holiday, the return is due on the next
business day and becomes delinquent on the next day thereafter. The original will be kept in the Department of
Revenue’s file, and the copy will be returned to the applicant or taxpayer immediately upon approval. The copy
will include the Department’s Certification Number. It is important that all code data be furnished and that such
data be accurate.
This application is to be used when applying for the following reduced gas severance tax rates:
(1) incapable gas well rate-$.013/MCF (applicable to a gas well that is incapable of producing an average of
250 MCF per day, under operating conditions, for the entire taxable period);
(2) incapable oil well gas rate-$.03/MCF (applicable to gas produced from an oil well with a wellhead pressure
of 50 psi gauge or less [under operating conditions-whether it be tubing flow or casing flow] throughout the
entire taxable period).
A copy of the latest DM1R (oil wells) or DT-1 (gas wells) form must be submitted with this application. Actual test
data submitted to the Office of Conservation on the DM1R and/or DT-1 must be identical to data appearing on the
DM1R and/or DT-1 submitted with this application and such data must support the basis for this application.
Wells that have been certified as incapable on this application and have been assigned the prefix “E” in the
Certification Number must be reported on the Incapable Well Report (Form SEV. G-3) every month if the reduced
rates are reported and paid on the Gas Severance Tax Return (Form SEV. G-1d). Failure to report incapable well
production on the Report Form SEV. G-3, when required, could result in the denial of reduced tax rate status.
Should any well certified as incapable for gas severance tax purposes subsequently become capable, the full
severance tax rates levied in Revised Statute 47:633(9) become due and payable.
DEFINITIONS
Name of applying company - Name of producer or authorized representative submitting application.
Revenue Account Number - This is your 10-digit Louisiana Tax Number.
Reporting Company number - Code assigned by the Office of Conservation or the Department of Revenue to
the reporting company.
Field name – Official name assigned by the Office of Conservation to identify a field. A separate application must
be submitted for each field.
Production Month – Period for which the reduced rate is requested.
Producer and lease name - Person or company under whose name gas is reported to the Office of Conservation
on its Form R-1 or R-5P. Lease name refers to official name assigned by the Office of Conservation to identify a
lease.
Conservation well number – Number assigned by the Office of Conservation to identify a well on a lease.
Parish - Field - Producer – Lease code - Well serial number - Codes assigned by the Office of Conservation.
Measurement method – Method of measurement prior to commingling with capable gas. Use Code 1 if gas is
metered; use Code 2 if measurement is determined by GOR well tests.
Wellhead pressure – Tubing, casing, or annular space pressure under which well is producing.
Method of producing code – Method under which the well is producing. See front of form for classification codes.
Well classification code – Either oil or gas well, as determined by the Office of Conservation. See front of this
form for codes.
Wells on reporting property –Total number of capable wells on property and total number of incapable wells on
property.
Taxpayer number – Purchaser or transporter code of the party responsible for payment of the tax.

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