Form Sv 3 - Ohio Severance Tax Return - 2002
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1Prescribed Form
SV 3 (Rev. 1/02)
P.O. Box 530= Columbus, OH 43216-0530
Ohio Severance Tax Return
Name:
Account No:
DBA:
Period:
Address:
(1)
(2)
(3)
(4)
Natural
Quantity
Tax
Tax
Resource
Extracted
Rate
Due
Coal
$ .09/ton
Salt
$ .04/ton
Limestone
$ .02/ton
Dolomite
$ .02/ton
Sand
$ .02/ton
Gravel
$ .02/ton
Oil
$ .10/bbl
Natural Gas
$ .025/mcf
Clay
$ .01/ton
Sandstone/Conglomerate
$ .01/ton
Shale
$ .01/ton
Gypsum
$ .01/ton
Quartzite
$ .01/ton
Total Tax Due:
Interest on Late Payment:
(see instructions)
Total Amount Remitted:
I declare under penalties of perjury that this return, 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 return and report.
Signature
Date
c
Check here to cancel your severer’s license:
Date Sold: _____________ or Discontinued: _____________
Please provide name and address of new owner(s) ____________________________________________________
_____________________________________________________________________________________________
c
Check here if you qualify for exemption:
Market value during period:
$ _______________________
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