Form 3000 - Severance Tax Report Gas - Wyoming Department Of Revenue Page 5
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8Severance Tax Form Instructions
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3000
SEVERANCE TAX REPORT
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:HVW WK 6WUHHW
GAS
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DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
O - Original
Form Type:
Taxpayer Name:
A - Amended
Contact Name:
Contact Phone Number:
352'8&7,21
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NOTE: For amended returns (Form
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Type ‘A’) report REPLACEMENT
Enter the gross sales value for the production
VALUES ONLY.
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period. Gross Sales Value includes all
revenue relating to the production for the
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reported period, including tax
Enter the remainder of
reimbursements and all other revenue
NOTE: A change in Rate Code
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Gross Sales Value minus
received or credited to all interest owners not
requires BOTH an amended report
Exempt Royalty and
taking in-kind and reporting on their own
for the originally reported rate code
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and an original report for the
Transportation.
behalf, and including all Federal, State, or
new rate code.
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Tribal royalty owner's, not taking royalty in-
kind, interest.
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NOTE: For amendments Total Tax
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Enter the value of the Federal, State, or Tribal
Due is the replacement amount and
Royalty exemptions, combined with the total
will not reflect previous tax applied
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allowable transportation costs and the total
to your account. Be sure to account
allowable processing deduction.
for tax previously applied to your
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account prior to remitting the
payment.
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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 3
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