Form 309 - Alaska Oil And Gas Production Tax Credit Under As 43.55.025 Applied To Tax Under As 43.55.011(E) Before It Is Issued As A Certificate

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Alaska Oil and Gas Production Tax Credit Under AS 43.55.025

309

Applied to Tax under AS 43.55.011(e) BEFORE it is Issued as a Certificate

Federal EIN

Date

Taxpayer Name

Mailing Address

City

State

Zip Code

Contact Person for Examination of Records

Title

Contact Email

Contact Phone Number

Contact Fax Number

Project Name

Area of Project (select from drop down)

Type of Interest in Project (Operator, Partner,

Single Explore, etc)

Blank

Apply Tax Credit earned under AS 43.55.025, but not yet issued as a certificate, to oil and gas production taxes owed under

AS 43.55.011(e) and allowed under 15 AAC 55.370(c) as follows:

Complete either section 1 or 2 below

1. For Exploration Projects still in Process (no AS 43.55.025 application filed yet):

Expected Project Completion Date

Total Qualifying Expenditures Incurred by Applicant To-Date

Credit %

0.00%

Total Credit To-Date

Total Amount Previously Applied to Tax Liability

Current Amount to Apply to Tax Liability

Tax Year to Apply Credit (attach summary if multiple years)

2. For Completed Exploration Projects (an AS 43.55.025 application* has been filed, but no certificates issued yet):

*All information below should tie to the AS 43.55.025 application.

AS 43.55.025 Application Date

Total Qualifying Expenditures Incurred by Applicant

Credit %

0.00%

Total Amount Requested as Credit

Total Amount Previously Applied to Tax Liability

Current Amount to Apply to Tax Liability

Tax Year to Apply Credit (attach summary if multiple years)

Note: The tax credit may only be applied against oil or gas production taxes due under AS 43.55. It may not be applied against interest, penalties, or

surcharges.

I declare under the penalty of perjury that I am authorized to sign on behalf of the taxpayer and this application and each attachment has been

examined by me and to the best of my knowledge and belief is true, correct and complete.

Signature

Type or Print Name and Title

Date

This form is available online at

Submit completed applications via the Tax Division Online Tax

Information System (OTIS) at

309

Mail to: Alaska Department of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555

0405-309 Rev 09/09/13