Form 384 "Exempt Production and Value Report by Well Schedule" - Michigan

What Is Form 384?

This is a legal form that was released by the Michigan Department of Treasury - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2010;
  • The latest edition provided by the Michigan Department of Treasury;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 384 by clicking the link below or browse more documents and templates provided by the Michigan Department of Treasury.

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Download Form 384 "Exempt Production and Value Report by Well Schedule" - Michigan

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Michigan Department of Treasury
384 (Rev. 11-10)
Exempt Production and Value Report by Well Schedule
A. Name
B. FEIN
C. Month
D. Year
E. Page No.
F. Type - Check and Report on One Fuel Only Per Form
Gas
NGLs
Condensate - Marginal/Stripper
Crude Oil-Regular
Condensate - Gas
Crude Oil – Marginal/Stripper
Condensate - Regular
EXEMPTION
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Name of Well
OGS Permit
Name of Producer
& County
Number or PRU
Gross Production
Entity
Share
Exempt Production
Unit Price
Exempt Value
TOTAL
TOTAL EXEMPT VOLUME (see instructions on Page 2)
TOTAL
TOTAL EXEMPT VALUE (see instructions on Page 2)
Reset Form
Michigan Department of Treasury
384 (Rev. 11-10)
Exempt Production and Value Report by Well Schedule
A. Name
B. FEIN
C. Month
D. Year
E. Page No.
F. Type - Check and Report on One Fuel Only Per Form
Gas
NGLs
Condensate - Marginal/Stripper
Crude Oil-Regular
Condensate - Gas
Crude Oil – Marginal/Stripper
Condensate - Regular
EXEMPTION
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Name of Well
OGS Permit
Name of Producer
& County
Number or PRU
Gross Production
Entity
Share
Exempt Production
Unit Price
Exempt Value
TOTAL
TOTAL EXEMPT VOLUME (see instructions on Page 2)
TOTAL
TOTAL EXEMPT VALUE (see instructions on Page 2)
Instructions for Form 384, Exempt Production and Value Report
This form is to be used ONLY when claiming an exemption on Form 381, Oil Severance Tax Return, and Form 382, Gas
Severance Tax Return.
Wells reported on this form are to be ONLY those wherein the State of Michigan, the government of the United States or
any political subdivisions receives proceeds.
The gross production and value must be reported and included on Form 383, Production Report, for acceptance as an
allowable deduction on this form.
Box A.)
Enter the filer’s legal individual or business Name.
Box B.)
Enter the filer’s nine digit Tax Identification Number.
Box C.)
Enter the two digit Month of the filing period reported.
Box D.)
Enter the four digit Year of the filing period reported.
Box E.)
Enter the Page number of the Report being filed.
Box F.)
Check only one fuel type per form.
Column 1 - Enter Name of the Producer.
Column 2 - Enter the Name and County of the Well.
Column 3 - Enter the OGS (Office of Geological Survey) assigned Permit Number or PRU for each well.
Column 4 - Enter the Gross Production for the Well reported. The Gross Production in this column must agree with the
gross production on Form 383.
Column 5 - Enter the name of the exempt entity. The entity must be shown by name. Example: State of Michigan, City of
Albion or U.S. Government.
Column 6 - The exempt entities’ share must be shown by fractional or decimal amount. Example: 1/8 or .125.
Column 7 - Determine the exempt production for each Well. Multiply column 6 by Column 4 to arrive at the amount for
Column 7. The grand total of Column 7 will be forwarded to Form 381 or Form 382, Column 1, as follows:
Form 382
Form 381
Gas Production: .............. Line 2
Crude Oil (Regular Wells): ............................. Line 2
NGL’s Production: ......... Line 6
Condensate (Regular Wells): .......................... Line 6
Condensate: ................... Line 10
Crude Oil (Stripper and Marginal Wells): ....... Line 10
Condensate (Stripper and Marginal Wells): .... Line 14
Column 8 - This Column must agree with the Unit Price shown on Form 383.
Column 9 - Multiply Column 7 by Column 8, to arrive at the amount in Column 9. The grand total of Column 9 will be
forwarded to Form 381 or 382, Column 2 as follows:
Form 382
Form 381
Gas Production: .............. Line 2
Crude Oil (Regular Wells): ............................. Line 2
NGL’s Production: ......... Line 6
Condensate (Regular Wells): .......................... Line 6
Condensate: ................... Line 10
Crude Oil (Stripper and Marginal Wells): ....... Line 10
Condensate (Stripper and Marginal Wells): .... Line 14
Mail the Severance Tax Return along with the Form 383 and 384 to:
Michigan Department of Treasury
P.O. Box 30474
Lansing, MI 48909-7974
Additional forms are available on Treasury’s web site at www.michigan.gov/taxes.
If you have any questions, call (517) 636-4600 Monday - Friday from 8 A.M. - 4:45 P.M.
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