Form R-9001 - Application For Certification Of Incapable Wells Gas Severance Tax
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1R-9001 (4/06)
Louisiana Department of Revenue
Application for Certification of Incapable Wells
Attn: Taxpayer Services Division
Gas Severance Tax
Severance Tax Section
FORM G-2
P.O. Box 66362, Baton Rouge, LA 70896-6362
Please print or type.
Name of applying company
Revenue Account Number
Reporting Company Number
Field Name
Do not write in this column.
Address: (street number, city, state, ZIP)
Production (MM/YYYY)
*Method of producing code
** Well classification code
FOR OFFICE USE ONLY.
1-Flowing
2-Gas lift
3-Pumping 4-Hydraulic lift
1-Oil well
2-Gas well
Number of wells
Well head
*Prod.
**Class
Daily avg.
Conservation codes
Measure
on lease
Producer’s name
Well
Parish
prod. during
pressure
Code
Code
ment
Taxpayer number
cal. month
Lease and Well name
Number
code
Well serial
Production
Field
Producer
Lease
Capable Incapable
Method
(MCF)
number
Code 1 only
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