Severance Tax Form Instructions
6WDWH RI :\RPLQJ
2002
SEVERANCE TAX SCHEDULE
'HSDUWPHQW RI 5HYHQXH
:HVW WK 6WUHHW
Oil Well Incentive Reporting
&KH\HQQH :<
DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
Taxpayer Name:
API NUMBER
352'8&7,21
5(3257,1*
5$7(
&2817<
:(//
6,'(75$&.
5(6(592,5
3(5,2'
*5283
&2'(
180%(5
180%(5
180%(5
180%(5
*5266 6$/(6 92/80(
*5266 6$/(6 9$/8(
7$;$%/( 9$/8(
PP\\\\
180%(5
1
Taxpayer’s name. Do not enter an
Taxpayer’s Operator ID as assigned by the
2
agent’s name here.
Wyoming Oil and Gas Conservation
Commission (WOGCC), or as assigned by
3
the Mineral Tax Division.
4
5
Month and year (mmyyyy). If you are an annual filer
report production for the entire year as December
6
(12yyyy).
7
Enter the five digit Reporting Group Number
8
assigned by the Mineral Tax Division.
9
Enter the proper Rate Code Identifier for the well
10
(see Rate Code Table).
11
12
Use Form 2002 to itemize oil well incentives. Individual wells in a Reporting Group that qualify
for well incentives, (Rate Code Table, Rate Type = Well), are itemized on Form 2002. A separate
13
line is required for each well qualifying for a well incentive. Group Incentives, (Rate Code Table,
14
Rate Type = Group), are not reported on Form 2002.
Report all volumes and values rounded to the nearest whole number.
Severance Tax Form 2002; page 1