Free 2005 Utah Oil & Gas Severance Tax Annual Return, TC-684 - Utah

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Utah State Tax Commission

Oil & Gas Severance Tax Annual Return

TC-684 Rev. 6/04

210 North 1950 West - Salt Lake City - Utah 84134 - (801) 297-2200 Get forms online - tax.utah.gov Tax year

Name and address
Due date Account number

Check this box if AMENDED return and enter the correct TAX YEAR being amended
1. TOTAL OIL & GAS TAXABLE VALUE at 3% (Total from all Schedule A, Line 20) 2. TOTAL OIL & GAS TAXABLE VALUE at 5% (Total from all Schedule A, Line 21) 3. TOTAL NGL TAXABLE VALUE at 4% (Total from all Schedule A, Line 22) 4. TOTAL INCREMENTAL TAXABLE VALUE (Total from all Schedule A, Line 23) 5. TOTAL TAXABLE VALUE (add lines 1 through 4) 6. OIL & GAS TAXES at 3% (multiply line 1 by .03) 7. OIL & GAS TAXES at 5% (multiply line 2 by .05) 8. NGL TAXES at 4% (multiply line 3 by .04) 9. INCREMENTAL TAXES at .015 and/or .025 or .02 (multiply line 4 by rate) 10. TOTAL TAX LIABILITY (add lines 6 through 9) 11. INSTALLMENTS/CREDIT (if applicable) a. CREDIT (carried forward from line 15 of previous years return) b. FIRST QUARTER INSTALLMENT c. SECOND QUARTER INSTALLMENT d. THIRD QUARTER INSTALLMENT e. FOURTH QUARTER INSTALLMENT 12. TOTAL INSTALLMENTS/CREDIT (add lines 11a through 11e) 13. TAX (subtract line 12 from line 10) 14. WORKOVER OR RECOMPLETION CREDIT (attach Schedule B) 15. TAX DUE or (CREDIT) (subtract line 14 from line 13) Check box if you want credit carried over to next year

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Penalties and interest will be computed as provided by law and billed by the Utah State Tax Commission for late filing and/or late payment. I have reviewed this report and certify the information to be accurate and complete. Authorized Signature X Date Signed Telephone number

INSTRUCTIONS FOR SEVERANCE TAX ANNUAL RETURN

Taxpayer name and address Enter name and address of company submitting this report. Tax Year Tax year covers one calendar year from 12:01 a.m. of the first day to 12:00 p.m. of last day. Due Date REPORT IS DUE on or before the first day of June following report period. Utah Account Number Enter Utah Account Number of company submitting report. Number is assigned by Utah Division of Oil, Gas and Mining Amended Return Check box if this report is changing or updating information previously submitted. LINE 1 LINE 2 LINE 3 LINE 4 LINE 5 LINE 6 LINE 7 LINE 8 LINE 9
TOTAL OIL & GAS TAXABLE VALUE AT 3% Enter Grand Total (all pages) brought forward from the Taxable Value at 3% line 20 on Schedule A (TC-684A). TOTAL OIL & GAS TAXABLE VALUE AT 5% Enter Grand Total (all pages) brought forward from the Taxable Value at 5% line 21 on Schedule A (TC-684A). TOTAL NATURAL GAS LIQUIDS TAXABLE VALUE AT 4% Enter Grand Total (all pages) brought forward from the NGL Taxable Value at 4% line 22 on Schedule A (TC-684A). TOTAL INCREMENTAL TAXABLE VALUE Enter Grand Total (all pages) brought forward from the Incremental Tax Value line 23 on Schedule A (TC-684A). TOTAL TAXABLE VALUE Add lines 1 through 4. OIL & GAS TAXES AT 3% Multiply line 1 by 3% (.03). OIL & GAS TAXES AT 5% Multiply line 2 by 5% (.05). NGL TAXES AT 4% Multiply line 3 by 4% (.04). INCREMENTAL TAXES 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, and approved by the Division of Oil, Gas and Mining on or after January 1, 1996. TOTAL TAX LIABILITY Add lines 6 through 9. INSTALLMENTS/CREDIT If applicable, enter any credit carried forward from line 15 of previous year's return and the amounts of previously paid installments to the Tax Commission for each of the four quarters on lines 11a through 11e. TOTAL INSTALLMENTS/CREDIT Add lines 11a through 11e. TAX Subtract line 12 from line 10. WORKOVER OR RECOMPLETION CREDIT A nonrefundable tax credit may be claimed equal to 20 percent of the expenses incurred in a recompletion or workover approved by the Division of Oil, Gas and Mining. The tax credit for each recompletion or workover may not exceed $30,000 per well during each calendar year. If the amount of the tax credit exceeds the tax liability for the calendar year, the unused portion of the tax credit may be carried forward for the next three calendar years. Attach TC-684B, Schedule B.

LINE 10 LINE 11

LINE 12 LINE 13 LINE 14

LINE 15 TAX DUE or (CREDIT) Subtract line 14 from line 13. This amount cannot be less than ZERO, unless it is to receive a credit or refund of actual taxes paid for the reported year. Check the box if you want to carry the credit over to the next year.