Form Sev G-3 - Monthly Incapable Well Report
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1State of Louisiana
Page ________ of ________
File original of this return only.
Department of Revenue
R-9002-L (12/03)
P.O. Box 201
G-3
FORM SEV
Baton Rouge, LA 70821-0201
Gas Severance Tax
MONTHLY INCAPABLE WELL REPORT
Reporting company name
Revenue Account Number
* Method of producing code
1-Flowing
2-Gas lift
3-Pumping
4-Hydraulic lift
Reporting company address (Street or P.O. Box, city, state, ZIP)
Reporting Company Number
Taxable Period
** Well classification code
*** Measurement method codes
1-Oil well
2-Gas well
1-Metered
2-GOR
3-SOR
***
*
**
Net
Conservation codes
Measure-
Gross
Field name
Method
Well
Cont.
taxable
ment
of
Producer name
Cert.
Conservation
Parish
class
production
Taxpayer
status
method
prod.
volume
Well
code
Lease and well name
code
well serial no.
code
Field
Producer
Lease
MCF
number
code
code
code
MCF
no.
This report is due on or before the fifteenth 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 report is due on
the next business day and becomes delinquent on the first day thereafter.
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