Form Sv 3 - Ohio Severance Tax Return
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Rev. 9/10
P .O. Box 530
Columbus, OH 43216-0530
Ohio Severance Tax Return
Name
Account No.
Address
Period
(1)
(2)
(3)
(4)
Natural Resource
Quantity Extracted
Tax Rate
Tax Due
1.
Coal
$ .10/ton
Additional Taxes on Coal
If you report any coal production, you must complete and attach Schedule SV 5, Additional Taxes on Coal.
1A.
Coal – Reclamation fund
$ .14/ton
1B.
Coal – Surface mining
$ .012/ton
2.
Salt
$ .04/ton
3.
Limestone
$ .02/ton
4.
Dolomite
$ .02/ton
5.
Sand
$ .02/ton
6.
Gravel
$ .02/ton
7.
Oil
$ .10/bbl
8.
Natural gas
$ .025/mcf
9.
Clay
$ .01/ton
10.
Sandstone/Conglomerate
$ .01/ton
11.
Shale
$ .01/ton
12.
Gypsum
$ .01/ton
13.
Quartzite
$ .01/ton
Total tax due:
0
Interest on late payment:
(see instructions)
Regulatory cost recovery
14.
Oil and Natural Gas Regulatory Cost Recovery (from SV 3A)*
payment due
*If you report any oil and/or natural gas production, you must complete and at-
Total amount remitted:
0
tach Schedule SV 3A.
I declare under penalties of perjury that this return, including any accompanying schedules and statements, has been examined by me
and, to the best of my knowledge and belief, is a true, correct and complete return and report.
Signature
Date
Check here to cancel your severer’s license:
Date sold:
or Discontinued:
Please provide name and address of new owner(s)
Enter market value here if you qualify for an exempt domestic well: $
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