Reporting Instructions Form For Oil And Gas Taxes - North Dakota Office Of State Tax Commissioner Page 32
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42NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
Form T-13
600 E. BOULEVARD AVE., BISMARCK, ND 58505-0599
(August 2000)
GAS GROSS PRODUCTION TAX REPORT
ORIGINAL
PRODUCER
(Check One)
(Check One)
AMENDED
PURCHASER
For Office Use Only
YEAR/MONTH
(i.e., 1999, 2000)
(i.e., 01, 12)
FEDERAL I.D. NUMBER
NAME
ADDRESS
PHONE
CITY
STATE/PROV.
ZIP CODE
For instruction booklet or forms contact the Office of State Tax Commissioner: 701-328-3593.
Hearing/speech impaired TTY users call Relay North Dakota 1-800-366-6888, ask for 701-328-3657.
You must attach all T-13 Worksheets to this Report.
GROSS PRODUCTION TAX
1.
Gross Production Tax Paid With Report ………………….….…………….…………...……………
Line 1 - Total from
Block 10 on T-13
2.
Penalty on Gross Production Tax ……………………………………………………
(See Instructions)…………….....…………
Worksheet
3.
Interest on Late Gross Production Tax …………..…….……
(See Instructions)………………..…………
4.
Total Due With This Report ...…..
(Add Lines 1, 2, and 3)………………………………….…………………..……………...………………….
5.
Tax Credits Claimed …….………..
(Enter as a positive value) ………………………………..……….….……………….………
6.
Total Gross Production Tax Remitted With This Report ………………..…...……….……..
(Line 4 minus Line 5) ……......
If Line 6 Results in Credit Balance, Apply to:
Credit
Refund
I declare under penalties of North Dakota Century Code Section 12.1-11.02, which provides for a Class A misdemeanor for making a false statement in a
government matter, that this report, including any accompanying schedules and statements has been examined by me and to the best of my knowledge and belief
is a true, correct, and complete report.
Report Prepared by:
Date:
(Please Print or Type)
Please Do Not Write In This Space
Check here if PAYMENT has been
submitted electronically.
Page 30
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