Form 4121 - Annual Gross Products Breakdown By County/tax District For Oil Page 4
ADVERTISEMENT
1
2
3
4
5Gross Products Tax Reporting Instructions
State of Wyoming
ANNUAL GROSS PRODUCTS
Department of Revenue
BREAKDOWN BY COUNTY/TAX
122 West 25th Street
4121
Cheyenne, WY 82002-0110
DISTRICT FOR OIL
Production Year:
__ __ __ __
TAXPAYER INFORMATION
PRODUCING ASSET
Operator ID
Revenue Use Only
Reporting Group Number
Taxpayer
Reporting Group Name
B. Tax District Breakdown of Taxable Value
County & Tax District
Volume Produced
Volume Sold
Taxable Value
County Prefixes
Albany
01
Natrona
25
Big Horn
03
Niobrara
27
Campbell
05
Park
29
Carbon
07
Platte
31
Converse
09
Sheridan
33
Crook
11
Sublette
35
Fremont
13
Sweetwater
37
Goshen
15
Teton
39
Hot Springs
17
Uinta
41
Johnson
19
Washakie
43
Laramie
21
Weston
45
Lincoln
23
The total must equal Form
Operators Only: the total must equal
The total must equal
Form 4101 Section D Line 4.
4101 Section D Line 6.
Form 4101 Section D
Line 9.
TOTALS
Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must
equal 4101, Section D, Line 9.
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.
MTS2
1/19/00
Authorized Signature
Title
Date
Form 4121 page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial