Form Rpd-41171 - Well Workover Project Application And Reporting Instructions printable pdf download

Form Rpd-41171 - Well Workover Project Application And Reporting Instructions

STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT

RPD - 41171

REV. 10/2003

Well Workover Project

Application and Reporting Instructions

(FORM RPD - 41171)

Name of Individual, Firm or Organization

OGRID Number (for Tax Filer)

Contact

Telephone Number

Mailing Address

City

State

Zip Code

Check One:

❑ Well Operator

❑ Working Interest Owner

❑ Purchaser

Multiple tax remitters may apply for Department approval on a single Form RPD-41171 provided ALL information is

completed using the above format.

PUN

PROPERTY NAME

POOL NAME/NUMBER

API NUMBER

❑

PRODUCT KIND

NATURAL GAS

AND/OR

OIL

PLEASE ATTACH A COPY OF THE OIL CONSERVATION DIVISION'S APPLICATION FOR QUALIFICATION OF

WELL WORKOVER PROJECT AND CERTIFICATION OF APPROVAL.

FOR DEPARTMENT USE ONLY

Certificate of Approval to Use Well Workover Incentive Tax Rate

Approval for use of the reduced severance tax rate of 2.45% on all production begins with sales month _____________ and the

Special Tax Rate Code is __________ .

Special Tax Rate Codes are required to be used on your Form RPD-41132, as it applies to the specific well completion and Production

Unit Number listed above.

Approved by

Date

- 45 -

Form Rpd-41171 - Well Workover Project Application And Reporting Instructions