Tax Rebate Check - Excel by aag27633

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									                                                               DEFERRED REBATE APPLICATION

328-DR                                                      E-Mail: gpdeferredrebate@tax.ok.gov
GPX

OPERATOR FEI/SSN
OPERATOR NAME
COMPANY REPORTING NUMBER
WELL NAME
PRODUCTION UNIT NUMBER                                  -          -      -

CHECK ONE:                       ULTRA DEEP WELL                         HORIZONTALLY DRILLED

    Tax Remitter       Product      Production Period            Net                    Net                       GP Tax           Rebate      Rebate
    Reporting #         Code        Month       Year            Volume                 Value                       Paid           Percentage   Amount




 TYPE OF REPORT (2)                                                                                             Total Rebate Claimed                    $0.00
Submitted by:                                                                 Date:                                        Telephone Number:

If submitted by an entity other than the
operator, provide the following:
                                  Name                                   Address                                   City             State       ZIP

Please check one:                Filing as an interest owner             Filing as representative of operator
                                GENERAL INSTRUCTIONS

PURPOSE - This application is to be used to apply for the refund of Gross Production Tax paid on
approved horizontal and ultra deep wells for the production periods of July through June 2010 and
2011.
No other types of rebates may be claimed on this form. This application shall only be
submitted via e-mail to the following address: gpdeferredrebate@tax.ok.gov

WHO IS ELIGIBLE TO APPLY – An operator or a designee who is approved by the operator to file on
behalf of all participating interest owners.

DATE APPLICATION IS TO BE SUBMITTED – Complete fiscal years shall be filed no later than
December 31st, 2011.



              INSTRUCTIONS FOR PREPARING FORM 328-DR
OPERATOR FEI/SSN: Enter the operator/working interest owner’s FEI or social security number.

OPERATOR NAME: Enter the well operator name.

COMPANY REPORTING NUMBER: Enter the operator/working interest owner’s number assigned by
the Oklahoma Corporation Commission.

WELL NAME: Enter the well name as registered on OTC form 320.

PRODUCTION UNIT NUMBER: Enter the production unit number assigned to the well by OTC Form
320-A. (List one production unit number per page).

CHECK ONE: Check appropriate box for which the well qualifies - ULTRA DEEP WELL or
HORIZONTAL WELL.

TAX REMITTER REPORTING NUMBER: Enter the tax remitter’s assigned company reporting
number.

PRODUCT CODE: Enter the code representing the product upon which GP Tax was paid. Product
codes shall be shown as one of the following: Code 1 = Oil, Code 5 = Natural Gas, Code 6 = Natural
Gas Liquids. Only one (1) product per page may be claimed.


PRODUCTION PERIOD: Enter month and year of product being produced (List one month per line).

NET VOLUME: Enter the net volume attributable to the well after approved deductions.

GP TAX PAID: Enter the amount of GP Tax remitted for the product produced for the specified
production month.


The remaining fields will be automatically calculated to reflect the amount of rebate due for the given
production month and a sum total of all months totaled at the bottom of the rebate amount column.

								
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