Form 3000 - Severance Tax Report Gas - Wyoming Department Of Revenue (Page 4 of 8) in pdf

Form 3000 - Severance Tax Report Gas - Wyoming Department Of Revenue Page 4

Severance Tax Form Instructions

6WDWH RI :\RPLQJ

3000

SEVERANCE TAX REPORT

'HSDUWPHQW RI 5HYHQXH

:HVW WK 6WUHHW

GAS

&KH\HQQH :<

DEPARTMENT OF REVENUE USE ONLY:

Operator ID:

O - Original

Form Type:

Taxpayer Name:

A - Amended

Contact Name:

Contact Phone Number:

352'8&7,21

5(3257,1*

5$7(

*5266 6$/(6

(;(037 52<$/7<

7$;$%/(

727$/ 7$; '8(

3(5,2'

*5283

&2'(

92/80(

9$/8(

352&(66,1* $1'

9$/8(

PP\\\\

180%(5

75$163257$7,21

NOTE: For amended returns (Form

Month and year (mmyyyy). If you are an annual filer

Type ‘A’) report REPLACEMENT

report production for the entire year as December

VALUES ONLY.

(12yyyy).

NOTE: A change in Rate Code

Enter the five digit Reporting Group Number

requires BOTH an amended report

assigned by the Mineral Tax Division.

for the originally reported rate code

and an original report for the

Enter the proper Rate Code Identifier for the Reporting

new rate code.

Group (see Rate Code Table). Form 3000 is used to enter

the combined Rate Code total for a specific Reporting

Group. Individual wells in a Reporting Group that qualify

NOTE: For amendments Total Tax

for well incentives must also be itemized on Form 3002.

Due is the replacement amount and

will not reflect previous tax applied

to your account. Be sure to account

Operators enter mcf sold, after deducting mcf

for tax previously applied to your

taken in-kind. Take In-Kind interest owners enter

account prior to remitting the

mcf taken in-kind.

payment.

MTSII 10/8/01

PAGE TOTAL:

I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete.

Authorized Signature

Title

Date

Severance Tax Form 3000; page 2

Form 3000 - Severance Tax Report Gas - Wyoming Department Of Revenue Page 4

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