Web Form 04-320 - Alaska Oil And Gas Exploration Tax Credit Applied To Oil & Gas Production Tax

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Alaska Oil and Gas Exploration Tax Credit Applied to
State of Alaska
Department of Revenue
Oil & Gas Production Tax
Tax Division
AS 43.55.025
550 W 7th Ave Ste 500
Anchorage AK 99501-3566
Telephone 907.269.6620
This form is available online at
Fax 907.269.6644
DEPT USE ONLY
A. Taxpayer Name
Federal EIN or SSN
B. Mailing Address
City
State
Zip Code + 4
C. Physical Address of Business
City
State
Zip Code + 4
D. Contact Person, for examination of records.
Title
Telephone Number
Facsimile Number
E. Production Tax Credit Certificate Number: ___________________________________________________
F. Production Tax Credit Amount Applied:
___________________________________________________
G. Apply Tax Credit to oil and gas production taxes owed for the months after July 1, 2004, as follows:
Production month & year:
Credit applied:
July, 2004 . . . . . . . . . . . . . . $
August, 2004 . . . . . . . . . . .
September, 2004 . . . . . . . .
October, 2004 . . . . . . . . . .
November, 2004 . . . . . . . .
December, 2004 . . . . . . . . .
January, 2005 . . . . . . . . . .
February, 2005 . . . . . . . . . .
March, 2005
. . . . . . . . . . .
April, 2005 . . . . . . . . . . . . .
May, 2005 . . . . . . . . . . . . . .
June, 2005 . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
Total credit applied
$
Unused carryover
$
H. Request a replacement certificate in amount of unused carryover? Enter Yes or No: __________________________________________
I declare under penalty of perjury that this application and each attachment has been examined by me and to the best of my
knowledge and belief is true, correct and complete.
Signature
Type or Print Name and Title
Date
DEPT USE ONLY
Web Form 04-320 (New 02/04)

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