Form Mt-05a - Remittance Form For Crude Oil Tax - 2013
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5KANSAS DEPARTMENT OF REVENUE
CUSTOMER RELATIONS
MINERAL TAX RETURN
TOPEKA, KANSAS 66625-0918
REGISTRATION I.D.NO.
REPORTING PERIOD THROUGH
MUST BE FILED AND PAID BY
CRUDE OIL
KCC
REMITTANCE FORM FOR CRUDE OIL TAX
TAX
$
Business Name and Address Area
PENALTY
INTEREST
NET ADJUSTMENT
TOTAL DUE
X
SIGNATURE
I certify that this is a true, correct and complete returns.
MT-05a
$
REMITTANCE
(Rev. 1/11)
Cut line
The "SAMPLE" above is showing what fields are required to be completed in order to process your
return. All of the fields (red boxes) are the required areas that must be completed. If they are not
completed your return will not be processed.
Enclosed with this sample are 12 blank returns, enough for each of your filing periods for tax year 2013.
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