instructions for 4121: annual gross products breakdown by tax district ...
INSTRUCTIONS FOR 4121: ANNUAL GROSS PRODUCTS BREAKDOWN BY TAX DISTRICT FOR OIL INSTRUCTIONS FOR 4221: ANNUAL GROSS PRODUCTS BREAKDOWN BY TAX DISTRICT FOR GAS
COMPLETE 4121 (oil) or 4221 (gas) FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. Multiple tax districts can be two or more districts in the same county or two or more districts in two or more counties. PRODUCTION YEAR: calendar year in which production occurred. TAXPAYER INFORMATION SECTION: Operator ID - Taxpayer's Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division of the Wyoming Department of Revenue. Taxpayer - Taxpayer's name. NOT agent. PRODUCING ASSET SECTION: Reporting Group Number - the Reporting assigned by the Mineral Tax Division.
Group
number
Reporting Group Name - Name of the producing asset. TAX DISTRICT BREAKDOWN OF TAXABLE VALUE Tax District - Enter county prefix and tax district. The county prefix and tax district of each well will be supplied to the operator by the Mineral Tax Division. EXAMPLE: Campbell County District 0100 would be 050100. Volume Produced - Operators enter volume produced and attributable to this tax district (well head volume). TIK interest owners skip this column. Volume Sold - Operators enter sales volume attributable to this tax district. TIK Interest owners enter volume taken in-kind attributable to this tax district.
Instructions for 4121 and 5221
Page 2
Taxable Value - Enter the dollar amount of 4101 Section D Line 9, attributable to the tax district listed. Totals - The total of the Volume Produced Column, (operators only), must equal 4101 Section D Line 4 (Oil), or 4201 Section C Line 1 (gas); the total of the Volume Sold Column must equal 4101 Section D Line 6 (oil), or 4201 Section D Line 6 plus Line 7 (gas); the total of the taxable value column must equal 4101 or 4201 Section D Line 9.
COUNTY PREFIXES Albany Big Horn Campbell Carbon Converse Crook Fremont Goshen Hot Springs Johnson Laramie Lincoln
01 03 05 07 09 11 13 15 17 19 21 23
Natrona Niobrara Park Platte Sheridan Sublette Sweetwater Teton Uinta Washakie Weston
25 27 29 31 33 35 37 39 19 43 45
rev. 12/5/2000
Gross Products Tax Reporting Instructions State of Wyoming Department of Revenue 122 West 25th Street Cheyenne, WY 82002-0110
!"#$#!%
ANNUAL GROSS PRODUCTS BREAKDOWN BY COUNTY/TAX DISTRICT FOR OIL
4121
Production Year: TAXPAYER INFORMATION Operator ID
Revenue Use Only
Calendar year in which production occurred.
Taxpayer
__ __ __ __ PRODUCING ASSET
Reporting Group Number
Reporting Group Name
B. Tax District Breakdown of Taxable Value
County & Tax District
Volume Produced
Volume Sold
Taxpayer’s Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division.
Reporting Group Name
Taxpayer’s name. Do not enter an agent’s name here.
Enter the County Prefix and Tax District. The County Prefix and Tax District of each well will be supplied to the Operator by the Mineral Tax Division. Example: Campbell County District 100 would be entered as 050100. Operators enter the volume produced and attributable to this Tax District. Take In-Kind Interest Owners skip this column.
Taxable Value
The Reporting Group Number assigned by the Mineral Tax Division
Operators enter sales volume attributable to this Tax District. Take In-Kind Interest Owners enter volume taken attributable to this Tax District. Enter the dollar amount of Form 4101 Section D Line 9 attributable to this Tax District.
TOTALS Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must equal 4101, Section D, Line 9. I declare under penalty of perjury that I have examined this return, and , to the best of my knowledge and belief, it is correct and complete.
COMPLETE FORM 4121 FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. MULTIPLE TAX DISTRICTS CAN BE TWO OR MORE DISTRICTS IN THE SAME COUNTY ORDate TWO OR Authorized Signature Title MORE DISTRICTS IN TWO OR MORE COUNTIES.
MTS2 1/19/00
Form 4121 page 1
Gross Products Tax Reporting Instructions State of Wyoming Department of Revenue 122 West 25th Street Cheyenne, WY 82002-0110
!"#$#!%
ANNUAL GROSS PRODUCTS BREAKDOWN BY COUNTY/TAX DISTRICT FOR OIL Production Year:
TAXPAYER INFORMATION Operator ID
4121
__ __ __ __ PRODUCING ASSET
Reporting Group Number
Revenue Use Only
Taxpayer
Reporting Group Name
B. Tax District Breakdown of Taxable Value
County & Tax District
Volume Produced
Volume Sold
Taxable Value
County Prefixes Albany Big Horn Campbell Carbon Converse Crook Fremont Goshen Hot Springs Johnson Laramie Lincoln
01 03 05 07 09 11 13 15 17 19 21 23
Operators Only: the total must equal Form 4101 Section D Line 4.
Natrona Niobrara Park Platte Sheridan Sublette Sweetwater Teton Uinta Washakie Weston
The total must equal Form 4101 Section D Line 6.
25 27 29 31 33 35 37 39 41 43 45
The total must equal 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.
Authorized Signature
Title
MTS2 1/19/00
Date Form 4121 page 2
!"#$#!
COMPLETE 4121 (oil) or 4221 (gas) FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. Multiple tax districts can be two or more districts in the same county or two or more districts in two or more counties. PRODUCTION YEAR: calendar year in which production occurred. TAXPAYER INFORMATION SECTION: Operator ID - Taxpayer's Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division of the Wyoming Department of Revenue. Taxpayer - Taxpayer's name. NOT agent. PRODUCING ASSET SECTION: Reporting Group Number - the Reporting assigned by the Mineral Tax Division.
Group
number
Reporting Group Name - Name of the producing asset. TAX DISTRICT BREAKDOWN OF TAXABLE VALUE Tax District - Enter county prefix and tax district. The county prefix and tax district of each well will be supplied to the operator by the Mineral Tax Division. EXAMPLE: Campbell County District 0100 would be 050100. Volume Produced - Operators enter volume produced and attributable to this tax district (well head volume). TIK interest owners skip this column. Volume Sold - Operators enter sales volume attributable to this tax district. TIK Interest owners enter volume taken in-kind attributable to this tax district.
Instructions for 4121 and 5221
Page 2
Taxable Value - Enter the dollar amount of 4101 Section D Line 9, attributable to the tax district listed. Totals - The total of the Volume Produced Column, (operators only), must equal 4101 Section D Line 4 (Oil), or 4201 Section C Line 1 (gas); the total of the Volume Sold Column must equal 4101 Section D Line 6 (oil), or 4201 Section D Line 6 plus Line 7 (gas); the total of the taxable value column must equal 4101 or 4201 Section D Line 9.
COUNTY PREFIXES Albany Big Horn Campbell Carbon Converse Crook Fremont Goshen Hot Springs Johnson Laramie Lincoln
01 03 05 07 09 11 13 15 17 19 21 23
Natrona Niobrara Park Platte Sheridan Sublette Sweetwater Teton Uinta Washakie Weston
25 27 29 31 33 35 37 39 19 43 45
rev. 12/5/2000
Gross Products Tax Reporting Instructions State of Wyoming Department of Revenue 122 West 25th Street Cheyenne, WY 82002-0110
!"#$#!%
ANNUAL GROSS PRODUCTS BREAKDOWN BY COUNTY/TAX DISTRICT FOR OIL
4121
Production Year: TAXPAYER INFORMATION Operator ID
Revenue Use Only
Calendar year in which production occurred.
Taxpayer
__ __ __ __ PRODUCING ASSET
Reporting Group Number
Reporting Group Name
B. Tax District Breakdown of Taxable Value
County & Tax District
Volume Produced
Volume Sold
Taxpayer’s Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division.
Reporting Group Name
Taxpayer’s name. Do not enter an agent’s name here.
Enter the County Prefix and Tax District. The County Prefix and Tax District of each well will be supplied to the Operator by the Mineral Tax Division. Example: Campbell County District 100 would be entered as 050100. Operators enter the volume produced and attributable to this Tax District. Take In-Kind Interest Owners skip this column.
Taxable Value
The Reporting Group Number assigned by the Mineral Tax Division
Operators enter sales volume attributable to this Tax District. Take In-Kind Interest Owners enter volume taken attributable to this Tax District. Enter the dollar amount of Form 4101 Section D Line 9 attributable to this Tax District.
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.
COMPLETE FORM 4121 FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. MULTIPLE TAX DISTRICTS CAN BE TWO OR MORE DISTRICTS IN THE SAME COUNTY ORDate TWO OR Authorized Signature Title MORE DISTRICTS IN TWO OR MORE COUNTIES.
MTS2 1/19/00
Form 4121 page 1
Gross Products Tax Reporting Instructions State of Wyoming Department of Revenue 122 West 25th Street Cheyenne, WY 82002-0110
!"#$#!%
ANNUAL GROSS PRODUCTS BREAKDOWN BY COUNTY/TAX DISTRICT FOR OIL Production Year:
TAXPAYER INFORMATION Operator ID
4121
__ __ __ __ PRODUCING ASSET
Reporting Group Number
Revenue Use Only
Taxpayer
Reporting Group Name
B. Tax District Breakdown of Taxable Value
County & Tax District
Volume Produced
Volume Sold
Taxable Value
County Prefixes Albany Big Horn Campbell Carbon Converse Crook Fremont Goshen Hot Springs Johnson Laramie Lincoln
01 03 05 07 09 11 13 15 17 19 21 23
Operators Only: the total must equal Form 4101 Section D Line 4.
Natrona Niobrara Park Platte Sheridan Sublette Sweetwater Teton Uinta Washakie Weston
The total must equal Form 4101 Section D Line 6.
25 27 29 31 33 35 37 39 41 43 45
The total must equal Form 4101 Section D Line 9.
TOTALS Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must equal 4101, Section D, Line 9. I declare under penalty of perjury that I have examined this return, and , to the best of my knowledge and belief, it is correct and complete.
Authorized Signature
Title
MTS2 1/19/00
Date Form 4121 page 2
!"#$#!
