Form Sev G-5 - Monthly Gas Well Report For Exempt Wells - 1997
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1R-9055-L (11/97)
State of Louisiana
G-5
FORM SEV
Department of Revenue
Page _________ of ________
Gas Severance Tax
P. O. Box 201, Baton Rouge, Louisiana 70821-0201
This report is to be filed with the Form R-9036A-L (G-1d),
File original of this return only.
Monthly gas well report for exempt wells
Gas Severance Tax Return - Lease Detail.
Reporting company name
Reporting company number
Report submitted during month of
Reporting company address (including ZIP code)
Revenue Account Number
Taxable
Conservation codes
Field name
period
Conservation
Parish
Taxpayer
Gross production
Value for payout of well cost
Producer name
well serial no.
number
code
MCF
Lease and Well name
Field
Producer
Lease
Mo.
Yr.
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