Form 04-320 - Alaska Oil And Gas Exploration Tax Credit Applied To Oil & Gas Production Tax

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Alaska Oil and Gas Exploration Tax Credit Applied to
State of Alaska
Department of Revenue
Oil & Gas Production Tax
Tax Division
AS 43.55.025
550 W 7th Ave Ste 500
Anchorage AK 99501-3566
Telephone 907.269.6620
This form is available online at
Fax 907.269.6644
DEPT USE ONLY
A. Taxpayer Name
B. Federal EIN or SSN
C. Mailing Address
D. City
E. State
F. Zip Code + 4
G. Physical Address of Business
H. City
I. State
J. Zip Code + 4
K. Contact Person, for examination of records.
L. Title
M. Telephone Number
N. Facsimile Number
O. Production Tax Credit Certificate Number: ___________________________________________________
P. Production Tax Credit Amount Applied:
___________________________________________________
Q. Apply Tax Credit to oil and gas production taxes owed on oil or gas produced on or after July 1, 2004, as follows:
Please note: The tax credit may only be applied against oil or gas production taxes due under AS 43.55. It may not be applied against
interest, penalties, or surcharges.
Credit applied with this tax filing
by production month/year
Production month & year
Credit applied
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
11.
$
12.
$
Total $
Unused carryover
$
R. Request a replacement certificate in amount of unused carryover? Enter Yes or No: __________________________________________
I declare under penalty of perjury that this application and each attachment has been examined by me and to the best of my
knowledge and belief is true, correct and complete.
S. Signature
T. Type or Print Name and Title
U. Date
V. DEPT USE ONLY
Form 04-320 webform (05/07)

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