Form 4121 Mtd - Annual Gross Products Mtd Autoform Breakdown By Tax District For Oil
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1State of Wyoming
ANNUAL GROSS PRODUCTS MTD
Department of Revenue
AUTOFORM BREAKDOWN BY
122 West 25th Street
4121 MTD
Cheyenne, WY 82002-0110
TAX DISTRICT FOR OIL
Production Year:
__ __ __ __
TAXPAYER INFORMATION
PRODUCING ASSET
Operator ID
Revenue Use Only
Lease or Group ID Number
Taxpayer
Lease Name or Unit Name
B. Tax District Breakdown of Taxable Value
Tax District
Volume Produced
Volume Sold
Taxable Value
TOTALS K
K
I declare under penalty of perjury that I have examined this return, and , to the best of my knowledge and belief, it is correct and complete.
PDFFORM
10/98
Authorized Signature
Title
Date
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