Form 2000 - Severance Tax Report Oil Page 3
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6DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
O - Original
Form Type:
Taxpayer Name:
A - Amended
Contact Name:
Contact Phone Number:
PRODUCTION
REPORTING
RATE
GROSS SALES
GROSS SALES
EXEMPT
TAXABLE
TOTAL TAX DUE
PERIOD
GROUP
CODE
VOLUME
VALUE
ROYALTY AND
VALUE
(mmyyyy)
NUMBER
TRANSPORTATION
NOTE: For amended returns
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(Form Type ‘A’) report
Enter the gross sales value for the production
VALUES ONLY.
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period. Gross Sales Value includes all
revenue relating to the production for the
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reported period, including tax
Enter the remainder of
reimbursements and all other revenue
NOTE: A change in Rate Code
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Gross Sales Value minus
received or credited to all interest owners not
requires BOTH an amended
Exempt Royalty and
for the originally reported rate
taking in-kind and reporting on their own
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code and an original report for the
Transportation.
behalf, and including all Federal, State, or
new rate code.
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Tribal royalty owner's interest.
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NOTE: For amendments Total
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Enter the value of the Federal, State, or Tribal
Tax Due is the replacement
Royalty exemption, if any, plus transportation
will not reflect previous tax applied
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"to market" costs which occur between the
to your account. Be sure to account
well head and point of sale for which you can
for tax previously applied to your
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produce invoices for verification.
account prior to remitting the
current payment.
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MTSII 10/8/01
PAGE TOTAL:
I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete.
Authorized Signature
Title
Date
State of Wyoming
2000
SEVERANCE TAX REPORT
Department of Revenue
*2000*
122 West 25th Street
OIL
Cheyenne WY 82002-0110
DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
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