Alternative Tax Credit For Oil And Gas Exploration Under As 43.55.025 Page 2

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Alaska
310
Alternative Tax Credit for Oil and Gas
Exploration under AS 43.55.025
Schedule A - Exploration Well
Federal EIN
Date of Claim
Name of Single Explorer or Designated Joint Applicant
Well qualifies under (select from drop down)
Qualifying exploration well name
AS 43.55.025(n) for 80% not to exceed $25,000,000
Date exploration well spudded
Surface location of qualifying well (attach a survey plat)
Date exploration well completed, suspended or abandoned
Bottom hole location of qualifying well (attach a survey plat)
Status of well
Boundary of nearest unit (attach a survey plat)
Unit boundary distance from qualifying well
Please Select Status
Nearest Preexisting Well Information
Bottom hole location of nearest preexisting well (attach a survey plat and
Date nearest preexisting well competed, suspended, or abandoned
map)
Horizontal bottom hole distance from nearest preexisting well
Qualified Exploration Well Expenditures
1) Drilling rig and drilling contractor cost
2) Drilling casings, tubings, equipment and supplies
3) Rig mobilization costs
4) Rig de-mobilization costs
5) Labor costs
6) In-state transportation of personnel
7) Transportation of equipment
8) Owned drilling equipment costs
9) Camp quarters and subsistence
10) Aviation or marine equipment, rental
11) Aviation or marine equipment, owned
12) Mapping and surveying
13) Fuel
14) Supplies
15) Repairs
16) Off site equipment, rental
17) Off site equipment, owned
18) Communications
19) Construction of roads, docks, heli-pads and landing strips
20) Abandonment
21) Well-logging, exploratory only
22) Other (describe)
23) Less: Reimbursements or payments received for qualifying expenditures
24) Total qualifying expenditures for credit
$
80.00%
25) Credit percentage allowed (30%, 40%, 80%, 90% or 100%)
26) Amount of credit claimed (line 24 x line 25)
0
$
Total claimed credit is carried to Exploration Credit Summary line.
This form is available online at
Submit completed applications via the Tax Division Online Tax
310
Information System (OTIS) at
0405-310 Rev 09/06/13- page 2

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