Form Ap-134 - Crude Oil And Natural Gas Texas Tax Questionnaire Page 2

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TEXAS TAX QUESTIONNAIRE

CRUDE OIL AND NATURAL GAS

SUSAN COMBS • COMPTROLLER OF PUBLIC ACCOUNTS

INSTRUCTIONS FOR COMPLETING TEXAS TAX QUESTIONNAIRE

FOR CRUDE OIL AND NATURAL GAS

WHO MUST SUBMIT THIS APPLICATION -

Item 4 - Enter the Federal Employer's Identification (FEI) Number

This application must be submitted by every person (sole owner,

assigned to your business by the Internal Revenue Service.

partnership, corporation or other organization) who produces and/or

Item 5 - Enter Social Security Number only if this is a sole owner.

purchases crude oil and/or natural gas.

Item 6 - If you have both a Texas Taxpayer and Vendor Identification

Number, enter only the first eleven digits of the Vendor Identification

WHO TO CONTACT FOR ASSISTANCE -

Number.

If you have any questions concerning this application, filing tax returns

Item 8 - OTHER ORGANIZATION: Explain the type of organization.

or any other tax-related matter, call 1-800-252-1384 toll free nation-

Examples: Social club, Independent School District, Family Trust, Joint

wide, or call 512/463-4600.

Venture. NOTE: For Joint Venture list the managing partner (or the

GENERAL INSTRUCTIONS -

partner acting as the authorized agent for the venture) and the names

• Please write only in white areas.

of two other principal partners. Principal partners are those having the

• When entering a Social Security Number, Federal Employer's

largest claim to a share of the venture's profits under the terms of the

Identification (FEI) number, Texas Taxpayer number or Vendor

Joint Venture Agreement. A copy of the Joint Venture Agreement must

Identification Number, do not enter dashes.

be filed with this questionnaire if the agreement is available.

• Disclosure of your social security number is required and authorized

TEXAS CORPORATION: Enter Charter Number assigned by the

under law, for the purpose of tax administration and identification of

Secretary of State and date of the charter.

any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i);

FOREIGN CORPORATION (Chartered out-of-Texas): Enter the state in

Tex. Govt. Code §§403.011 and 403.078. Release of information on

which business is incorporated and Charter Number AND Texas

this form in response to a public information request will be

Certificate of Authority Number and date.

governed by the Public Information Act, Chapter 552, Government

LIMITED PARTNERSHIP: Enter state in which partnership is registered

Code, and applicable federal law.

and identification number.

Item 9 - PARTNERSHIP: Enter information for all partners. If a partner

SPECIFIC INSTRUCTIONS -

is a corporation, enter the Federal Employer's Identification (FEI)

Item 1 - SOLE OWNER: Enter first name, middle initial and last name.

Number of the corporation.

PARTNERSHIP: Enter the legal name of the partnership.

CORPORATION or OTHER ORGANIZATION: Enter the information

CORPORATION: Enter legal name exactly as it is registered with the

for the principal officers (president, secretary, vice-president).

Secretary of State.

Item 10 - CRUDE OIL PRODUCERS: If the taxes are not paid by the

OTHER ORGANIZATION: Enter the title of the organization.

purchaser, please call us for permission to file monthly.

Item 2 - Enter complete mailing address where you wish to receive

NATURAL GAS PRODUCERS: If average monthly tax liability is less

mail from the Comptroller of Public Accounts. If you wish to receive

than $200 or an accumulated liability per year is $2,400 or less, then

mail at a different address for other taxes, attach a letter with other

reports must be filed annually.

addresses.

Item 3 - Enter your Comptroller taxpayer number.

15. SIGNATURES Sole owner, all general partners or corporation president or authorized representative must sign. (Attach additional sheets, if necessary.)

Texas Railroad Commission P-5 number

Date of application for P-5 number

I (We) declare that the information in this document is true and correct to the best of my (our) knowledge and belief.

Type or print name of sole owner, partner or officer

Sole owner, partner or officer

Type or print name of partner or officer

Partner or officer

Type or print name of partner or officer

Partner or officer

Field office

Complete this application and mail to:

COMPTROLLER OF PUBLIC ACCOUNTS