Form 10-166 - Amended Crude Oil Tax - Purchaser Report
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410-166
(Rev.6-12/3)
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b.
36190
a.
under Chapters 552 and 559, Government Code, to
You have certain rights
review, request and correct information we have on file about you. Contact us
at the address or phone number listed on this form.
Texas Comptroller of Public Accounts
Amended CRUDE OIL Tax -- PURCHASER Report
Page 1 of ______
c. Taxpayer number
d. Due date
e. Filing period
f.
FM
h.
i.
Taxpayer name and mailing address
g.
Blacken this box if your address
1
has changed.
THIS REPORT PAGE MUST ACCOMPANY ANY LEASE DETAIL SUPPLEMENT
PAGES (Form 10-170) FOR THIS REPORTING PERIOD. It is recommended
that supplement pages be completed prior to completing this page.
ENTER NET ADJUSTED AMOUNTS
STATEWIDE DATA
(Crude oil unidentifiable as to producer, lease, scrubber, SWD, etc.)
1. Statewide barrels
(See instructions. Enter whole barrels.)
1.
2. Net taxable value of designated "statewide" purchases
$
(See instructions. Enter dollars and cents.)
2.
SUMMARY DATA
(See Instructions)
3. Taxable barrels from lease detail supplements
3.
(Total from Item 15 on all attached Lease Detail Supplements. Enter whole barrels.)
4. Net taxable value from lease detail supplements
$
4.
(Total from Item 19 on all attached Lease Detail Supplements. Enter dollars and cents.)
5. Total taxable barrels
(Add Item 1 and Item 3. Enter whole barrels.)
5.
6. Total net taxable value
$
6.
(Add Item 2 and Item 4. Enter dollars and cents.)
7. Regulatory tax and fee assessment
$
7.
(Multiply Item 5 x
. Enter dollars and cents.)
8. Tax due
$
8.
(Multiply Item 6 x
. Enter dollars and cents.)
$
9. Total tax and fee due
(Add Items 7 and 8. Enter dollars and cents.)
9.
10-166
(Rev.6-12/3)
* * * DO NOT DETACH * * *
$
10. Overpayment
10.
(Credit Transfer Form for Crude Oil Tax, Form 10-141, must be included.)
$
11. Net amount due
11.
(Item 9 minus Item 10)
$
12. Penalty & Interest
12.
(If tax is paid after the due date, see instructions.)
$
13. TOTAL AMOUNT DUE AND PAYABLE
(Item 11 plus Item 12)
13.
Taxpayer name
m.
T Code
Taxpayer number
Period
Make the amount in Item 13 payable to:
36020
36020
State Comptroller
Mail to:
I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief.
Comptroller of Public Accounts
Print name
Business phone (Area code and number)
P.O. Box 149358
Austin, TX 78714-9358
Taxpayer or duly authorized agent
Date
l.
777
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