Form G-1s - Gas - Parish Summary Certification - 2001
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1G-1s
R-9037-L (4/01)
State of Louisiana
Page __________ of ___________
Reporting company name
Reporting company number
Department of Revenue
File original of this return only.
Severance Tax Division
Street or post office address
Revenue Account Number
P. O. Box 201
Baton Rouge, LA 70821-0201
City, State, ZIP
Report submitted during month of
Gas – Parish Summary
Tax
Taxable period
Certification
Parish
rate
Parish name
code
code
Net taxable MCF
Amount due
Month
Year
Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best
of my knowledge and belief, it is true, correct, and complete.
$
I understand that the information repor ted on this return will be used in the administration and enforcement of the severance
tax laws, rules, and regulations, and may be disclosed to other par ties involved in these repor ted transactions.
$
Please print or type.
$
Name and title
Signature
(
)
$
Date
Telephone
This retur n is due on or before the 15th day of the second month following the taxable period and becomes delinquent on the
$
first day thereafter. If the due date falls on a weekend or holiday, the return is due the next business day and becomes delinquent
the first day thereafter. See special instructions for additional filing requirements for taxpayers with liabilities equal to or in
excess of $20,000. Report all volumes in MCF (15.025 pounds absolute pressure and 60°F).
$
Section below to be completed on last sheet of form G-1s only. See reverse side for instructions.
$
Tax
Tax
rate
$
Total
Total
rate
per
Summary
taxable MCF
amount due
code
MCF
$
See table
Full rate – capable gas
1
$
.
on back.
$
Incapable rate – oil well gas
2
3¢
.
$
Incapable rate – gas well gas
3
1.3¢
.
$
Approved contracts at less than 52¢ per MCF
7
7¢
.
Produced Water Injection Incentive-Approved Projects Only
$
See table
Produced water-Full rate
1P
.
on back.
$
Produced water-Incapable rate-oil well gas
2P
2.4¢
.
$
Produced water-Incapable rate-gas well gas
3P
1.04¢
.
$
$
Penalty and interest
6
.
$
Grand total
$
.
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