Form Sev G-3 - Monthly Incapable Well Report
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1G-3
FORM SEV
Gas Severance Tax
R-9002 (07/06)
Page ________ of ________
File original of this return only.
MONTHLY INCAPABLE WELL REPORT
Louisiana Department of Revenue
P.O. Box 201
Baton Rouge, LA 70821-0201
PLEASE PRINT OR TYPE.
Reporting company name
Revenue Account Number
* Method of producing code
1-Flowing
2-Gas lift
3-Pumping
4-Hydraulic lift
Reporting company address (including ZIP code)
Reporting Company Number
Taxable Period
** Well classification code
*** Measurement method codes
1-Oil well
2-Gas well
1-Metered
2-GOR
3-SOR
***
*
**
Field name
Cont.
Conservation codes
Cert.
Conservation
Parish
Taxpayer
Meas.
Well
Gross
Net taxable
Method
Producer name
status
Well
method
of prod.
class
code
well serial no.
code
production MCF
volume MCF
number
Field
Producer
Lease
Lease and well name
code
no.
code
code
code
This report is due on or before the twenty-fifth day of the second month following the taxable period and becomes delinquent on the first day thereafter. If the due date falls on a weekend or
holiday, the return is due on the next business day and becomes delinquent on the first day thereafter.
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