Form Mt-5 - Mineral Tax Page 4
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5KANSAS DEPARTMENT OF REVENUE
MINERAL TAX
915 SW HARRISON ST
TOPEKA KS 66612-1588
REGISTRATION I.D.NO.
JULY 31, 2013
SEPTEMBER 20, 2013
REPORTING PERIOD THROUGH
MUST BE FILED AND PAID BY
GAS SEVERANCE
KCC
REMITTANCE FORM FOR NATURAL GAS SEVERANCE TAX
TAX
$
PENALTY
INTEREST
NET ADJUSTMENT
TOTAL DUE
X
SIGNATURE
I certify that this is a true, correct and complete returns.
MT-5
$
REMITTANCE
(Rev. 6/13)
KANSAS DEPARTMENT OF REVENUE
MINERAL TAX
915 SW HARRISON ST
TOPEKA KS 66612-1588
REGISTRATION I.D.NO.
AUGUST 31, 2013
OCTOBER 22, 2013
REPORTING PERIOD THROUGH
MUST BE FILED AND PAID BY
GAS SEVERANCE
KCC
REMITTANCE FORM FOR NATURAL GAS SEVERANCE TAX
TAX
$
PENALTY
INTEREST
NET ADJUSTMENT
TOTAL DUE
X
SIGNATURE
I certify that this is a true, correct and complete returns.
MT-5
$
REMITTANCE
(Rev. 6/13)
KANSAS DEPARTMENT OF REVENUE
MINERAL TAX
915 SW HARRISON ST
TOPEKA KS 66612-1588
REGISTRATION I.D.NO.
REPORTING PERIOD THROUGH
SEPTEMBER 30, 2013
MUST BE FILED AND PAID BY
NOVEMBER 20, 2013
GAS SEVERANCE
KCC
REMITTANCE FORM FOR NATURAL GAS SEVERANCE TAX
TAX
$
PENALTY
INTEREST
NET ADJUSTMENT
TOTAL DUE
X
SIGNATURE
I certify that this is a true, correct and complete returns.
MT-5
$
REMITTANCE
(Rev. 6/13)
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