Form 0405-332.1 - Alaska Oil And Gas Production Tax Credits Under As 43.55.024(A) Additional Nontransferable Tax Credit Page 2

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Alaska Oil and Gas Production Tax Credit
State of Alaska
Department of Revenue
under AS 43.55.024 (c)
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#
Average Daily Oil Production
Average Daily Gas Production
Unit Operator
G. Production Tax Credit Under AS 43.55.024(c) for this tax year …………………………………………………… $
H. Production Tax Credit under AS 43.55.024(c)(1) for the tax year as follows:
1) Producer's tax credit under AS 43.55.024(c)(1) if the producer's average daily production
is not more than 50,000 Btu equivalents, enter here and on Line G …………………………………………… $
2) Producer's average daily production in Btu equivalents, if claiming a tax credit
under AS 43.55.024(c)(1) …………………………………………………………………………………………..
Btu Eq's.
I. Production Tax Credit under AS 43.55.024(c)(2) for the tax year as follows:
Producer's tax credit under AS 43.55.024(c)(2) if the producer's average daily production is more than 50,000 Btu equivalents
and less than 100,000 Btu equivalents:
1) Producer's average daily production in Btu equivalents …………………………………………………………
Btu Eq's.
50,000
2) Base amount of Btu equivalents ……………………………………………………………………………………
Btu Eq's.
3) Producer's Btu equivalents in excess of 50,000, subtract Line (2) from Line (1) ……………………………
Btu Eq's.
4) Multiply Producer's Btu equivalents in excess of 50,000 by 2 and enter result ………………………………
Btu Eq's.
5) Divide result in Line (4) by 100,000 and enter result ……………………………………………………………
6) Subtract result in Line (5) from 1.0 and enter result ……………......……..……….………..…...…..…………
7) Multiply $12,000,000 by the fraction in Line (6) and enter result
as the producer's AS 43.55.024(c)(2) credit for the calendar year,
enter here and on Line G above …………………………………………………………………………………… $
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 0405-332.2 web new 03/07 • page 2

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