Lat 12 - Personal Property Report - Oil And Gas Property

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CONFIDENTIAL:
(RS 47:2327) FORMS FILED BY A TAXPAYER SHALL BE USED BY THE ASSESSOR, THE
GOVERNING AUTHORITY, AND THE LOUISIANA TAX COMMISSION SOLELY FOR THE PURPOSE
OF ADMINISTERING THIS STATUTE
LEGAL CITATION AND INSTRUCTIONS: THIS REPORT SHALL BE FILED WITH THE ASSESSOR OF THE PARISH INDICATED BY
ST
APRIL 1
OR WITHIN 45 DAYS AFTER RECEIPT, WHICHEVER IS LATER, IN ACCORDANCE WITH RS 47:2324.
-USE ATTACHMENTS IF NECESSARY-
PERSONAL PROPERTY REPORT – OIL AND GAS PROPERTY
LAT 12
YEAR
RETURN TO:
WARD:
ASSESSMENT NO.
NAME/ADDRESS (Indicates any Changes)
PARISH
WARD:
FIELD NAME AND CODE NUMBER
LOCATION
SECTION
TOWNSHIP
RANGE
OWNER/PERSON TO CONTACT
PHONE
SHADED AREA FOR ASSESSOR’S OFFICE USE ONLY – USE ATTACHMENTS IF NECESSARY
DESCRIPTION OF ALL PROPERTY OWNED IN WARD – SUBMIT SEPARATE REPORT FOR EACH WARD
LEASE
FAIR
DESCRIPTION OF WELLS AND/OR
ACTUAL
WELL
WELL
ACTIVE
ASSESSED
WELL
MARKET
SERIAL NUMBER
TYPE
LOWER PERF
VALUE
SURFACE EQUIPMENT BY LEASE
AGE*
NUMBER
VALUE
SUMMARY OF PROPERTY IN WARD AND FIELD
PROPERTY
FAIR MARKET
ASSESSED
PROPERTY
FAIR MARKET
ASSESSED
CLASS
VALUE
VALUE
CLASS
VALUE
VALUE
LAT 12 ATTACHMENT A – COMPLETE A SEPARATE ATTACHMENT FOR EACH WELL SERIAL NUMBER
SIGNATURE AND VERIFICATION
I declare under the penalties for filing false reports that this return has been examined by me and to the best of my knowledge and belief is a
true, correct and complete return. If the return is prepared by other than the taxpayer, his declaration is base on all information relating to the
matters required to the reported in the return of which he has knowledge.
SIGNATURE OF TAXPAYER
DATE
PRINTED/TYPED NAME OF TAXPAYER
12/28/2015
REVISION DATE:

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