Form 61 - Nebraska Severance And Conservation Tax Return
Download a blank fillable Form 61 - Nebraska Severance And Conservation Tax Return in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 61 - Nebraska Severance And Conservation Tax Return with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3FORM
Nebraska Severance and Conservation Tax Return
61
Complete and attach required schedules.
Nebraska ID Number
Federal ID or Social Security Number
PLEASE DO NOT WRITE IN THIS SPACE
45 —
PRINT FORM
RESET FORM
Tax Month and Year
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Business Name
Business Name
Street Address
Street or Other Mailing Address
City
State
Zip Code City
State
Zip Code
1 Total value of stripper oil severed (total of lines 4a on all Schedules I and II) ...................................
1
2 Total value of nonstripper oil severed (total of lines 4b on all Schedules I and II) .............................
2
3 Total value of natural gas severed (total of lines 4c on all Schedules I and II) ..................................
3
4 Total value of all resources severed (total of lines 1 through 3) .........................................................
4
5 Total severance tax due from school lands (total of lines 6 on all Schedules I) .................................
5
6 Total severance tax due from other than school lands (total of lines 6 on all Schedules II) ..............
6
7 Total severance tax due (line 5 plus line 6) ...............................................
7
8 Severance tax interest ..............................................................................
8
9 Severance tax penalty ..............................................................................
9
10 Total severance tax, interest, and penalty (total of lines 7, 8, and 9) ................................................. 10
11 Total conservation tax due (line 4 multiplied by .0040) .............................
11
12 Conservation tax interest ..........................................................................
12
13 Conservation tax penalty ..........................................................................
13
14 Total conservation tax, interest, and penalty (total of lines 11, 12, and 13) ....................................... 14
15 BALANCE DUE (total of lines 10 and 14). Pay in full with this return ................................................ 15
Under penalties of law, I declare that I have examined this return, including accompanying schedules, and to the best of my knowledge and belief, it is
correct and complete.
sign
here
Signature of Owner, Partner, Member, Corporate Officer, or Duly Authorized Individual
Signature of Preparer Other Than Taxpayer
(
)
Title
Date
Phone
Address
Date
Email Address
Email Address of Preparer
Mail original return, schedules, and payment to:
Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
, 800-742-7474 (NE and IA), or 402-471-5729
Mail copy to: Oil and Gas Conservation Commission, PO Box 399, Sidney, NE 69162-0399.
3-2013
5-105-1975 Rev.
Supersedes 5-105-1975 Rev. 7-2011
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial