Form 0405-332.1 - Alaska Oil And Gas Production Tax Credits Under As 43.55.024(A) Additional Nontransferable Tax Credit

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Alaska Oil and Gas Production Tax Credits
State of Alaska
under AS 43.55.024(a)
Department of Revenue
Tax Division
Additional Nontransferable Tax Credit
550 W 7th Ave Ste 500
Anchorage AK 99501-3566
This form is available online at
Phone 907.269.6620
Fax 907.269.6644
DEPT USE ONLY
FSN
A. Producer or Explorer Name
Tax Period Ending
B. Mailing Address
City
State
Federal EIN
C. Physical Address of Business
City
State
Zip Code + 4
D. Contact Person for Examination of Records
Title
Phone Number
Fax Number
E. Contact Email Address
Business Type
Corporation
Partnership
Sole Proprietorship
LLC
Other _____________
F. Lease or Property, Name or ADL#
Location (attach map)
Unit Operator
G. Production tax liability under AS 43.55.011(e) or (f) before application of any credits under AS 43.55.024 …………………….…………
$
H. Production Tax Credit Under AS 43.55.024(a) for the tax year ……………………………………………………………………………….
$
Note: To be eligible for a credit under AS 43.55.024(a), the tax liability on Line G above must exceed zero.
IMPORTANT: To claim a credit under AS 43.55.024(a) and/or (c), attach the Application Required by AS 43.55.024(e), Form 0405-332.3.
I declare under penalty of perjury that this application and each attachment have been examined by me and to the best of my
knowledge and belief are true, correct and complete and that I am authorized to act on behalf of the filer.
Signature
Print Name and Title
Date
DEPT USE ONLY
Form 0405-332.1 web new 03/07 • page 1

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