Form 325 - Application For Cash Purchase Of Alaska Oil And Gas Production Tax Credit Certificates Page 2

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Alaska

325

Application for Cash Purchase of Alaska Oil

and Gas Production Tax Credit Certificates

under AS 43.55.028

Federal EIN

Tax Year

Taxpayer Name

Schedule A

The following conditions, under AS 43.55.028(e), must be met for the State to consider an application to purchase an Alaska Oil and Gas Tax Credit

Certificate:

The calendar year of the purchase is not earlier than the first calendar year for which the credit shown on the certificate notification letter would

otherwise be allowed to be applied against tax;

The applicant does not have any outstanding liability with the state for unpaid delinquent taxes under this title;

The applicant’s total tax liability under AS 43.55.011(e), after application of all available tax credits, for the calendar year in which the application

is made is zero;

The applicant’s average daily production of oil and gas taxable under AS 43.55.011(e) during the calendar year preceding the calendar year in

which the application is made was not more than 50,000 BTU equivalent barrels; and

The purchase is consistent with AS 43.55.028 and the regulations adopted under 15 AAC 55.325.

I certify that the applicant meets all of the conditions outlined above from AS 43.55.028(e) and am unaware of any reason why they would not

qualify to receive a cash payment from the state under AS 43.55.028 and the associated regulations.

Signature

Date

Printed Name

Printed Title

DEPT USE ONLY

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