Form 9036-L - Gas Severance Tax Return - Lease Detail - Department Of Revenue - Louisiana
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1R-9036-L (12/03)
State of Louisiana
G-1d
Department of Revenue
P. O. Box 201
Baton Rouge, LA 70821-0201
Page _______ of _______
Gas Severance Tax Return - Lease Detail
File original of this return only.
Reporting company name
Reporting company number
Revenue Account Number
This return is due by the 15th day of the second month following the taxable period and becomes delinquent on
the first day thereafter. If the due date falls on a weekend or holiday, the return is due on the next business day
and becomes delinquent on the first day thereafter. See special instructions for additional filing requirements for
Reporting company address, city, state, ZIP
Taxable Period
taxpayers with liabilities equal to or in excess of $15,000. Report all volumes in MCF (15.025 pounds absolute
pressure and 60°F).
Conservation codes
Gross gas production
Exclusions
Field name
Producer name
Tax
Lease and Well name
Plant
Taxpayer
rate
Plant name
Parish
Field
Producer
Lease
code
code
code
MCF
Code
MCF
Code
MCF
Code
MCF
Net taxable MCF
Tax and interest
Totals (to be entered on last page of
return if more than one page is used)
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