Form Idr-283 - Oil And Gas Production Asssessment Return - 2002

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Illinois Department of Revenue
IDR-283
Oil and Gas Production Assessment Return
Station 374
Do not write above this line.
Step 1: Identify your business
1
3
Name _______________________________________________
Liability period ___ ___ - ___ ___ ___ ___
Month
Year
2
4
Address _____________________________________________
Daytime telephone number (______)_______________________
Number and street
____________________________________________________
City
State
ZIP
Step 2: Figure your oil and gas production assessment due
5
5
Write your total proceeds of production for this liability period.
$_________________l_____
6
6
Multiply Line 5 by 0.1% (.001). This amount is the oil and gas production assessment due.
$_________________l_____
Make your check payable to “Illinois Department of Revenue.”
Step 3: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
_______________________________________________________
______________________________________________________
Taxpayer's signature
Telephone
Date
Tax preparer’s signature
Telephone
Date
Mail your payment and completed return to: Illinois Department of Revenue, P.O. Box 19467, Springfield, IL 62794-9467.
This form is authorized by the Illinois Petroleum Education and Marketing Act. Disclosure of this information is REQUIRED. Failure to
IDR-283 front (R-7/02)
provide information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-3506
Illinois Department of Revenue
IDR-283
Oil and Gas Production Assessment Return
Station 374
Do not write above this line.
Step 1: Identify your business
1
3
Name _______________________________________________
Liability period ___ ___ - ___ ___ ___ ___
Month
Year
2
4
Address _____________________________________________
Daytime telephone number (______)_______________________
Number and street
____________________________________________________
City
State
ZIP
Step 2: Figure your oil and gas production assessment due
5
5
Write your total proceeds of production for this liability period.
$_________________l_____
6
6
Multiply Line 5 by 0.1% (.001). This amount is the oil and gas production assessment due.
$_________________l_____
Make your check payable to “Illinois Department of Revenue.”
Step 3: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
_______________________________________________________
______________________________________________________
Taxpayer's signature
Telephone
Date
Tax preparer’s signature
Telephone
Date
Mail your payment and completed return to: Illinois Department of Revenue, P.O. Box 19467, Springfield, IL 62794-9467.
This form is authorized by the Illinois Petroleum Education and Marketing Act. Disclosure of this information is REQUIRED. Failure to
IDR-283 front (R-7/02)
provide information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-3506
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