Form 4201 - Annual Gross Products For Gas Page 9
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12Gross Products Tax Reporting Instructions
State of Wyoming
ANNUAL GROSS PRODUCTS
Department of Revenue
FOR GAS
122 West 25th Street
4201
Cheyenne, WY 82002-0110
TAXPAYER INFORMATION
Production Year:
__ __ __ __
Enter mcf sold (Line 3 minus Line 4 for operators; volume
Operator ID
Revenue Use Only
taken in-kind for take in-kind interest owners).
PRODUCING ASSET
Taxpayer
Reporting Group Number
(skip to line 7 if you have plant products) Enter the gross sales value for
Contact Person / Agent
the year where no plant products are involved. Gross Sales Value
Telephone Number
Reporting Group Name
includes all revenue relating to the production for the reported year,
Address
Field Name
including tax reimbursements and all other revenue received or credited
to all interest owners not taking in-kind and reporting on their own
City
State
Zip
County
behalf, and including all Federal, State, or Tribal royalty owner's interest.
O = Original
O = Operator
A. Form Type:
B. Taxpayer Type:
A = Amended
T = Take in-Kind Interest Owner
Enter the gross sales value for the year where plant products are involved. Gross
Sales Value includes all revenue relating to the production for the reported year,
Explanation for Amendment:
including tax reimbursements and all other revenue received or credited to all
interest owners not taking in-kind and reporting on their own behalf, and
C. Gross MCF Calculation (Complete by Operator ONLY)
including all Federal, State, or Tribal royalty owner's interest. Complete and
1)
Total Well-Head Production
include Form 4231 when plant products are involved.
2a Flared/Blown MCF
2b Re-injection MCF
2c Field Use MCF
2d Other MCF
2)
Total Well-Head Deductions (Line 2a + 2b + 2c + 2d)
Enter the value of the Federal Royalty Exemption, if any.
3)
Gross Production at Mouth (Line 1 minus Line 2)
NOTE: if the exemption exceeds 12.5% of Line 7, attach an
TIK Interest Owner Volume Taken - COMPLETE BY OPERATOR ONLY
explanation.
TIK Interst Owner Name
TIK Operator ID
Volume Taken
4a)
Enter the State Royalty Exemption, if any.
4b)
4c)
TIK Interest Owner Volume Taken from 4211 MTD
4d)
Enter the Tribal Royalty Exemption, if any.
Total Take In-Kind Volume - (Line 4a + 4b + 4c + 4d)
4)
D. Taxable Value Calculation
Gross Sales Volume of Natural Gas (Line 3 minus Line 4)
5)
Gross Sales Value of Natural Gas (No Plant Products)
6)
7)
Gross Sales Value of Plant Products (Complete Form 4231)
8a Federal Royalty $
8b State Royalty $
8c Tribal Royalty $
8d Processing $
Type A Transportation
Type B Transportation
Type C Transportation
Enter allowable plant processing costs. Line 7 must contain a value
8e)
Total Transportation Deductions
and Form 4231 must be completed and included to report a
8)
Total Deductions (8a + 8b + 8c + 8d + 8e)
processing deduction.
Taxable Value - (Line 6 plus Line 7 minus Line 8)
9)
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.
MTS2
Authorized Signature
Title
Date
Form 4201 Page 5
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial