Free TC-684A, Severance Tax Annual Return - Schedule A - Utah


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State: Utah
Category: Tax Forms
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http://tax.utah.gov/forms/current/tc-684a.pdf

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Severance Tax Annual Return - Schedule A
Taxpayer's name Address City Utah account number Tax year Field number

Page ___ of ___ Pages

TC-684A Rev. 12/07

AMENDED REPORT
Operator Field name Interest owner First purchaser Other: _______

Field Total 1. Amended + 2. Producing entity no. 3. Product type
Volume: Oil-in bbls Gas-in mfc NGL-in gals

GRAND Total (all pages)

Get forms online tax.utah.gov DO NOT WRITE IN THIS AREA

4. Transported 5. Reported by others 6. Subject to tax (line 4 - line 5)

7. Gross product value 8. Processing deduction 9. Transportation deduction 10. Net product value (line 7 - lines 8 & 9)

11. Exempt royalties 12. Net taxable value amount (subtract line 11 from line 10) 13. Stripper production value 14. First six months development well value 15. First twelve months wildcat well value Taxable amount 16. (Subtract lines 13, 14, 15 from line 12) Oil & Gas 17. Taxable value at 3% 18. Taxable value at 5%

19. NGL taxable value at 4% Incremental tax value (Oil & 20. Gas at 1.5%, Oil & Gas at 2.5%, and NGL at 2%)

Instructions for Schedule A
Complete a separate Schedule A for each Field. Round all volumes and values.
Taxpayer Name and Address Enter name and address of company submitting this repor t. Check appropriate box to indicate repor ting as an Operator, Interest Owner, First Purchaser or Other. If Operator box is checked, complete all columns. If a box other than Operator is checked, complete all columns except Transpor ted and Repor ted by Others. Utah Account Number Enter the Utah account number of company submitting this repor t. This number is assigned by the Utah Division of Oil, Gas and Mining. Tax Year Tax year covers one calendar year from 12:01 a.m. of first day to 12:00 p.m of last day. REPORT IS DUE on or before the first day of June . following the tax year. Field Number and Name Enter number and name of field designated by the Field Names Advisor y Committee, Utah Division of Oil, Gas and Mining. Amended Report Check the amended repor t box if this repor t is changing or updating information previously submitted. 1. Amended (+-): Use this line only when an amended repor t is filed. Amended repor ts include only specific product and pricing entity being corrected. Repor t should contain the following: Original Entr y :Enter a minus (-) to indicate original entr y being deleted. Entr y should be written as it appeared on original return .Corrected Entry :Use a plus (+) on second column to indicate corrected entry. 2. Producing Entity Number: Enter number assigned to producing entity by Utah Division of Oil, Gas and Mining. 3. Product Type: Enter one of the following codes for product type: OLOil; GS-Gas; NL-Natural Gas Liquids 4. Transpor ted: Entries on this line should be made only by the operator. Enter quantity of product produced, saved, and sold or transpor ted from producing entity. 5. Repor ted by Others: Enter volume of product taken-in-kind by another par ty. If entr y is made on this line, form TC-806 should be submitted. 6. Subject to Tax: Volume subject to tax equals volume transpor ted minus repor ted by others, line 5. 7. Gross Product Value: Gross product value is value determined for volume subject to tax before deductions. 8. Processing deduction: Enter the amount of processing costs, as defined by Utah Code 59-5-101, allowable as a deduction from the gross product value. A schedule with a detailed breakdown of these costs taken as a deduction, must be provided. 9. Transpor tation deduction: Enter the amount of transpor tation costs, as defined by Utah Code 59-5-101, allowable as a deduction from the gross product value. A schedule with a detailed breakdown of these costs taken as a deduction, must be provided. 10. Net Product Value: Net product value equals gross product value minus processing and transpor tation deductions. 11. Exempt Royalties: Deduct the amount of royalties equal to the percentage of exempt royalty interest attributable to the United States, State of Utah, Bureau of Indian Affairs and/or Indian Tribe. 12. Net Taxable Value Amount: Subtract exempt royalties, line 11 from net product value, line 10. 13. Stripper Production Value: Enter net value of qualifying well or wells as defined under Utah Code 59-5-101 within the entity. Provide a schedule by API number showing qualifying production and value. Do not include any amounts previously deducted as exempt royalties (line 11). 14. First Six (6) Months Development Well Value: Enter net value of production from qualifying development well or wells within the entity. Provide a schedule by API number showing qualifying production and value. An exemption from the payment of severance tax is allowed for a period of six months following the first day of production. Do not include any amount previously deducted as exempt royalties (line 11). 15. First Twelve (12) Months Wildcat Well Value: Enter net value of production from qualifying wildcat well or wells as defined under Utah Code 59-5-101 within the entity. Provide a schedule by API number showing qualifying production and value. An exemption from the payment of severance tax is allowed for a period of twelve months following the first day of production. Do not include any amount previously deducted as exempt royalties (line 11). 16. Taxable Amount: Taxable amount equals taxable net value amount, line 12, minus the value attributable to stripper, line 13, first six months, line 14, and first twelve months, line 15, production exemptions. 17. Oil & Gas Taxable Value at 3%: 3% of the value up to and including the first $13 per barrel for oil. 3% of the value up to and including the first $1.50 per mcf for gas. 18. Oil & Gas Taxable Value at 5%: 5% of the value from $13.01 and above per barrel for oil. 5% of the value from $1.51 and above per mcf for gas. 19. NGL taxable at 4%: The severance tax rate for natural gas liquids is 4% of the taxable value for natural gas liquids. 20. Incremental Tax Value: A 50% reduction in the tax rate is imposed upon the "Incremental production" achieved from an "Enhanced recovery project," as defined by Utah Code 59-5-101. Provide a schedule showing the amount of incremental production volume and value. Field Total: Enter the field totals for lines 7 through 20 on the last page of the Schedule A used for each field. Grand Total: Enter on the last Schedule A used the Grand Total of all field totals.