Form 10-140 - Texas Crude Oil Producer Special Report
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1
210-140
TEXAS CRUDE OIL PRODUCER
(Rev.8-05/17)
SPECIAL REPORT
b.
Do not write in the space above
Page 1.
10060
a. T Code
d. Filing period
c. Taxpayer number
e. (yymm)
Taxpayer name and mailing address
f.
g.
h.
TYPE OR PRINT
SEE INSTRUCTIONS ON REVERSE SIDE
Round to whole barrels.
Two decimals are required on all dollar values.
1. Lease name (as recorded with the Texas Railroad Commission)
2. County of production
3. Your/other party name
4. Type 5. County code 6. Lease no./Check digit
7. Expanded EOR
8. Your/other party number
9. Are you the
10. Gross barrels
11. Exempt barrels
lease operator?
(rounded)
(rounded)
NO
YES
Baseline Incremental
1
2
0
1
12. Taxable barrels
13. Gross value
14. You are liable
15. API gravity 16. Exempt value
17. Trucking costs
18. Net taxable value
(rounded)
for tax?
.
1
1. Lease name (as recorded with the Texas Railroad Commission)
2. County of production
3. Your/other party name
4. Type 5. County code 6. Lease no./Check digit
7. Expanded EOR
8. Your/other party number
9. Are you the
10. Gross barrels
11. Exempt barrels
lease operator?
(rounded)
(rounded)
YES
NO
Baseline Incremental
1
2
1
0
12. Taxable barrels
13. Gross value
14. You are liable
15. API gravity 16. Exempt value
17. Trucking costs
18. Net taxable value
for tax?
(rounded)
.
1
1. Lease name (as recorded with the Texas Railroad Commission)
2. County of production
3. Your/other party name
4. Type 5. County code 6. Lease no./Check digit
7. Expanded EOR
8. Your/other party number
9. Are you the
10. Gross barrels
11. Exempt barrels
lease operator?
(rounded)
(rounded)
NO
YES
Baseline Incremental
1
2
0
1
12. Taxable barrels
13. Gross value
14. You are liable
15. API gravity 16. Exempt value
17. Trucking costs
18. Net taxable value
for tax.
(rounded)
.
1
10070
REPORT TOTALS AND TAX COMPUTATION
i. T Code
19. Total net taxable value
23. Amount of tax and fee due
(Line 21 plus Line 22)
20. Total taxable barrels
(See instructions)
24. Late filing penalty and interest
(See instructions)
21. Tax Due
(Line 19 x
)
25. TOTAL AMOUNT DUE AND PAYABLE
(Line 23 plus Line 24)
22. Regulatory tax and fee assessment
(Line 20 x
)
Please mark reason:
Other
Lost
Stolen
Unaccounted for
(Specify)
I declare that the information in this document and any attachments is true and correct to the best of my
Make the amount in Item 25 payable to:
knowledge and belief.
STATE COMPTROLLER
Taxpayer or Duly Authorized Agent
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
111 E. 17th Street
Phone (Area code and number)
Date
Austin, Texas 78774-0100
If you have any questions regarding Crude Oil or Natural Gas tax, call 1-800-252-1384, toll free, nationwide.
The Austin number is 512/463-4600.
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