Form 330 - Tax Credit Summary And Certificate Request For Oil And Gas Production Tax Credits Page 7

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330
Alaska
Oil and Gas Production Tax Credits
under AS 43.55.023
Schedule B-4: Members of a Consortium of Explorers
Federal EIN
Date of Claim
Tax Period
Taxpayer Name
Exploration project name or description (as entered on schedule B-1)
Proportion of the cost ($) of the exploration project incurred by applicant
Proportion of interest in project (%)
0.00%
Relationship of applicant to the consortium of explorers (partner, joint venturer, operator, or other)
Signature
Print Name & Title
Date
List Below Each Member of a Consortium of Explorers Participating in this Exploration Project
Company
Contact Name
Phone Number
Contact Email
Mailing Address
City
State
Zip Code
Proportion of interest in project (%)
Explorer’s relationship to the consortium of explorers (partner, joint
venturer, operator, or other)
0.00%
Company
Contact Name
Phone Number
Contact Email
Mailing Address
City
State
Zip Code
Proportion of interest in project (%)
Explorer’s relationship to the consortium of explorers (partner, joint
venturer, operator, or other)
0.00%
Company
Contact Name
Phone Number
Contact Email
Mailing Address
City
State
Zip Code
Proportion of interest in project (%)
Explorer’s relationship to the consortium of explorers (partner, joint
venturer, operator, or other)
0.00%
Company
Contact Name
Phone Number
Contact Email
Mailing Address
City
State
Zip Code
Proportion of interest in project (%)
Explorer’s relationship to the consortium of explorers (partner, joint
venturer, operator, or other)
0.00%
This form is available online at
Submit completed applications via the Tax Division’s Online Tax
330
Information System (OTIS) at
0405-330 Rev 03/19/13 - page 7

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