Form Tc-05 - Quarterly Oil And Gas Conservation Tax Return

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TC-5 Rev. 9/94
AMENDED REPORT
REPORT PERIOD ENDING
TAXPAYER NAME
DUE DATE
UTAH ACCOUNT NUMBER
QUARTERLY OIL AND GAS CONSERVATION TAX RETURN
Volume
Royalties
Operator/
Amend
Product
Taxable
Producing
Prod.
Subject to
Reported by
Other
Value
Amount
+ -
Federal
Entity No.
State
Indian
Type
Transported
Others
Tax
$
I have read this report and certify the information to be accurate and complete.
TOTAL TAXABLE AMOUNT
$
Authorized signature
Preparer name
TAX DUE (Taxable amount X.002)
Telephone
Date
$
GRAND TOTAL (Tax due all pages)

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