Form 360 - Alaska Oil And Gas Production Tax Refund Request

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360
Alaska Oil and Gas Production Tax
Refund Request
This form must be completed, signed, and submitted via the Online Tax Information System (OTIS) at
or sent to the address below with supporting documentation.
Taxpayer Information:
EIN: ______________________ Taxpayer Name: ______________________________________ Date:____________________
PPT Refund Information:
Acct. Code:
Tax Period:
Oil and Gas Production Tax
(60701)
Conservation Surcharge ($0.04)
(60712)
Conservation Surcharge ($0.01)
(60713)
Penalties
(60716)
Interest
(60717)
Total
(60700)
ELF Refund Information:
Acct. Code:
Tax Period:
Oil Production Tax
(60651)
Gas Production Tax
(60654)
Conservation Surcharge ($0.03)
(60659)
Conservation Surcharge ($0.02)
(60661)
Flare Penalties
(60653)
Interest
(60656)
Total
(60650)
Company Name
Company Address
Contact Phone #
Printed Name of Authorized Agent
Signature of Authorized Agent
Mail to: PRODUCTION TAX GROUP
This form is available online at
DEPARTMENT OF REVENUE, TAX DIVISON
550 W 7TH AVE STE 500
ANCHORAGE AK 99501-3555
Phone 907.269.6620 - Fax 907.269.6644
360
Retain a copy for your records
0405-360 Rev 03/12

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