Form 2000 - Severance Tax Report Oil Page 6
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6State 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:
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
ADDRESS:
PERIOD
GROUP
CODE
VOLUME
VALUE
ROYALTY AND
VALUE
(mmyyyy)
NUMBER
TRANSPORTATION
CITY:
1
STATE:
ZIP:
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NOTE: For amended returns (Form
4
Type ‘A’) report REPLACEMENT
VALUES ONLY.
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NOTE: A change in Rate Code requires
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BOTH an amended report for the
originally reported rate code and an
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original report for the NEW rate code.
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NOTE: For amendments Total Tax Due
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is the replacement amount and will not
reflect previous tax applied to your
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account. Be sure to account for tax
Previously applied to your account prior
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to remitting the current payment.
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Rev 09/16/2011
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
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