66-100
b.
(Rev.4-08/8)
PRINT
TEXAS COASTAL PROTECTION FEE REPORT
66100
a.
ENTER WHOLE BARRELS ONLY
DO NOT WRITE IN SHADED AREAS
c. Fee payer number
d. Filing period
f. Due date
e.
IMPORTANT
Blacken this box if your mailing
g. Name and mailing address (Make any necessary name or address changes below.)
address has changed. Show changes
by the preprinted information.
1.
Blacken this box if you are no
longer in business and write in the
2.
date you went out of business.
Month
Day
Year
h.
i.
j.
1. Terminal operator
2. Terminal identification (Name and/ or location)
YES
NO
6. Net barrels subject to fee
3. Total barrels at this terminal
4. Fee-paid barrels
5. Barrels with fee paid by owner
(Item 3 minus Items 4 and 5)
1. Terminal operator
2. Terminal identification (Name and/ or location)
YES
NO
6. Net barrels subject to fee
3. Total barrels at this terminal
4. Fee-paid barrels
5. Barrels with fee paid by owner
(Item 3 minus Items 4 and 5)
1. Terminal operator
2. Terminal identification (Name and/ or location)
YES
NO
6. Net barrels subject to fee
3. Total barrels at this terminal
4. Fee-paid barrels
5. Barrels with fee paid by owner
(Item 3 minus Items 4 and 5)
1. Terminal operator
2. Terminal identification (Name and/ or location)
YES
NO
6. Net barrels subject to fee
3. Total barrels at this terminal
4. Fee-paid barrels
5. Barrels with fee paid by owner
(Item 3 minus Items 4 and 5)
Calculate the amount of fee due.
7. Total barrels of crude oil, including condensate,
transferred to/from vessels at marine terminal(s)
7.
(Total of Item 3 for ALL terminals)
8. Number of fee-paid barrels (Total of Item 4 for ALL terminals)
8.
9. Number of barrels fee paid by owner of crude oil/condensate (Total of Item 5 for ALL terminals)
9.
10. Net barrels subject to fee
10.
(Item 7 minus Item 8 and Item 9. Same as total of Item 6)
11. Amount of fee per barrel
11.
0.01333
12. TOTAL FEE DUE (Multiply Item 10 by Item 11)
12.
66-100 (Rev.4-08/8)
13. Penalty due (See instructions)
13.
14. Interest (See instructions)
14.
15. TOTAL AMOUNT DUE AND PAYABLE (Item 12 plus Item 13 and Item 14)
15.
k.
l.
Taxpayer name
T Code
Taxpayer number
Period
I declare that the information in this document and any attachments is true and correct to
the best of my knowledge and belief.
Duly authorized agent
Make check payable to: STATE COMPTROLLER
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
P.O. Box 149360
Business phone
Date
Austin, Texas 78714-9360
For assistance call (800) 252-1384 toll free nationwide, or call (512) 463-4600.