Form 3000 - Severance Tax Report
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6State of Wyoming
3000
SEVERANCE TAX REPORT
Department of Revenue
*3000*
122 West 25th Street
Enter ‘O’ for an original report. Enter ‘A’ for an
GAS
Cheyenne WY 82002-0110
amended report.
DEPARTMENT OF REVENUE USE ONLY:
Operator ID:
O - Original
Form Type:
Taxpayer Name:
A - Amended
Contact Name:
Contact Phone Number:
PRODUCTION
REPORTING
RATE
GROSS SALES
GROSS SALES
EXEMPT ROYALTY
TAXABLE
TOTAL TAX DUE
PERIOD
GROUP
CODE
VOLUME
VALUE
PROCESSING AND
VALUE
(mmyyyy)
NUMBER
TRANSPORTATION
NOTE: For amended returns (Form
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Taxpayer’s name. Do not enter an
Taxpayer’s Operator ID as assigned by the
Type ‘A’) report REPLACEMENT
agent’s name here.
Wyoming Oil and Gas Conservation
VALUES ONLY.
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Commission (WOGCC), or as assigned by
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the Mineral Tax Division.
Contact Person or Agent's telephone number including area code and
extension.
NOTE: A change in Rate Code
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requires BOTH an amended report
for the originally reported rate code
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and an original report for the
new rate code.
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Name of the person, agent, or agency responsible for completing this report who can answer
questions regarding this report.
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NOTE: For amendments Total Tax
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Due is the replacement amount and
Use Form 3000 to report gas and plant products including plant condensate (liquids
will not reflect previous tax applied
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to your account. Be sure to account
separated at a main processing plant).
for tax previously applied to your
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account prior to remitting the
Always report volumes and values except Total Tax Due rounded to the nearest whole
payment.
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number. Total Tax Due must be reported to the cent.
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MTSII 10/8/01
PAGE TOTAL:
I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete.
Authorized Signature
Title
Date
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