Form R-9001-L - Application For Certification Of Incapable Wells - Louisiana Department Of Revenue

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R-9001-L (2/04)
Application for Certification of
Louisiana Department of Revenue
Incapable Wells
P.O. Box 201, Baton Rouge, Louisiana 70821-0201
Gas Severance Tax
G-2
FORM SEV
Name of applying company
Revenue Account Number
Reporting Company Number
Field Name
Address: street number, city, state, ZIP
Production Month
**Well
*Method of
This column is for
1 - Flowing
3 - Pumping
classification code
producing code
2 - Gas lift
4 - Hydraulic lift
use by the
1 - Oil well 2 - Gas well
Department of
Well head
Daily avg.
No. of wells on
*Prod.
**Class
Conservation codes
Producer’s name
code
code
reporting property
Revenue
Well
pressure
Taxpayer
prod. during
Measure
number
number
cal. month
Well serial
ment
Lease and well name
Parish
Capable
In-capable
code
Field
Producer
Lease
number
method
(MCF)

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