Form T-12 "Oil Gross Production and Oil Extraction Tax Report" - North Dakota

What Is Form T-12?

This is a legal form that was released by the North Dakota Office of State Tax Commissioner - a government authority operating within North Dakota. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on August 1, 2000;
  • The latest edition provided by the North Dakota Office of State Tax Commissioner;
  • 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 printable version of Form T-12 by clicking the link below or browse more documents and templates provided by the North Dakota Office of State Tax Commissioner.

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NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
FORM T-12
600 E. BOULEVARD AVE., BISMARCK, ND 58505-0599
(August 2000)
OIL GROSS PRODUCTION AND OIL EXTRACTION TAX REPORT
ORIGINAL
PRODUCER
(Check One)
(Check One)
AMENDED
PURCHASER
YEAR/MONTH
(i.e., 1999, 2000) (i.e., 01, 12)
For Office Use Only
FEDERAL I.D. NUMBER
NAME
ADDRESS
PHONE
CITY
STATE/PROV.
ZIP CODE
For instruction booklet or forms contact the Office of State Tax Commissioner: 701-328-3593.
Hearing/speech impaired TTY users call Relay North Dakota 1-800-366-6888, ask for 701-328-3657.
You must attach all T-12 Worksheets to this Report.
GROSS PRODUCTION TAX
1.
Gross Production Tax Paid With Report ………………….….…………….…………...……………
Line 1 - Total from
Block 8 on T-12
2.
Penalty on Gross Production Tax ……………………………………………………
(See Instructions)…………….....…………
Worksheet
3.
Interest on Late Gross Production Tax …………..…….……
(See Instructions)………………..…………
4.
Total Due ……...……
(Add Lines 1, 2, and 3) …………………..……………………………………………...…………..………………………
OIL EXTRACTION TAX
5.
Oil Extraction Tax Paid With Report ……………...…………………...………………………………
Line 5 - Total from
Block 13 on T-12
6.
Penalty on Oil Extraction Tax ……………………………………………………………
(See Instructions)……………..……………
Worksheet
7.
Interest on Late Oil Extraction Tax …………...……………
(See Instructions)…..…………….…………
8.
Total Due …..………
(Add Lines 5, 6, and 7) ……………………………..…………………………...……………………………………
9.
Total Due With This Report ...…..
(Add Lines 4 and 8)………………………………….…………………..……………...………………….
10.
Tax Credits Claimed …….………..
(Enter as a positive value) ……………….….………………………………...……….………
11.
Total Gross Production and Oil Extraction Tax Remitted With This Report …………...……….……..
(Line 9 minus Line 10) ……......
If Line 11 Results in Credit Balance, Apply to:
Credit
Refund
I declare under penalties of North Dakota Century Code Section 12.1-11.02, which provides for a Class A misdemeanor for making a false statement in a government
matter, that this report, 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 report.
Report Prepared by:
Date:
(Please Print or Type)
Please Do Not Write In This Space
Check here if PAYMENT has been
submitted electronically.
NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
FORM T-12
600 E. BOULEVARD AVE., BISMARCK, ND 58505-0599
(August 2000)
OIL GROSS PRODUCTION AND OIL EXTRACTION TAX REPORT
ORIGINAL
PRODUCER
(Check One)
(Check One)
AMENDED
PURCHASER
YEAR/MONTH
(i.e., 1999, 2000) (i.e., 01, 12)
For Office Use Only
FEDERAL I.D. NUMBER
NAME
ADDRESS
PHONE
CITY
STATE/PROV.
ZIP CODE
For instruction booklet or forms contact the Office of State Tax Commissioner: 701-328-3593.
Hearing/speech impaired TTY users call Relay North Dakota 1-800-366-6888, ask for 701-328-3657.
You must attach all T-12 Worksheets to this Report.
GROSS PRODUCTION TAX
1.
Gross Production Tax Paid With Report ………………….….…………….…………...……………
Line 1 - Total from
Block 8 on T-12
2.
Penalty on Gross Production Tax ……………………………………………………
(See Instructions)…………….....…………
Worksheet
3.
Interest on Late Gross Production Tax …………..…….……
(See Instructions)………………..…………
4.
Total Due ……...……
(Add Lines 1, 2, and 3) …………………..……………………………………………...…………..………………………
OIL EXTRACTION TAX
5.
Oil Extraction Tax Paid With Report ……………...…………………...………………………………
Line 5 - Total from
Block 13 on T-12
6.
Penalty on Oil Extraction Tax ……………………………………………………………
(See Instructions)……………..……………
Worksheet
7.
Interest on Late Oil Extraction Tax …………...……………
(See Instructions)…..…………….…………
8.
Total Due …..………
(Add Lines 5, 6, and 7) ……………………………..…………………………...……………………………………
9.
Total Due With This Report ...…..
(Add Lines 4 and 8)………………………………….…………………..……………...………………….
10.
Tax Credits Claimed …….………..
(Enter as a positive value) ……………….….………………………………...……….………
11.
Total Gross Production and Oil Extraction Tax Remitted With This Report …………...……….……..
(Line 9 minus Line 10) ……......
If Line 11 Results in Credit Balance, Apply to:
Credit
Refund
I declare under penalties of North Dakota Century Code Section 12.1-11.02, which provides for a Class A misdemeanor for making a false statement in a government
matter, that this report, 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 report.
Report Prepared by:
Date:
(Please Print or Type)
Please Do Not Write In This Space
Check here if PAYMENT has been
submitted electronically.
North Dakota Statement of Oil Purchases/Sales
T-12 WORKSHEET - OIL
Gross Production & Oil Extraction Tax
(August 2000)
YEAR/MONTH
(i.e., 1999, 2000)
(i.e., 01, 12)
FEDERAL I.D. NUMBER
TAXPAYER NAME
Page
of
Gross Production Tax
Oil Extraction Tax
Barrels of Oil
Value of Exempt
Other Party
Value of Oil
Taxable Value of Oil
Pool
Well
Taxable Value of Oil
Purchased/Sold
Government
Federal I.D.
Purchased/Sold
(Block 2 - Block 3)
Code
Code
(Same as Block 4)
(Round to two Places)
Royalties
Number
1
2
3
4
A
B
9
14
5
10
15
Oil
Posting
Additional
Transportation
Other
Total Production Tax Due
Total Extraction Tax Due
Gravity
Code
Value
Deduction
Deductions
(5% of Block 4)
(4% or 6.5% of Block 9)
C
D
E
F
G
6
11
16
Production Tax
Extraction Tax
Previously Paid
Previously Paid
API Number:
Sequence #
Condensate
7
12
17
Production Tax Paid
Extraction Tax Paid
YES
By Others
By Others
33 -
(
)
8
13
Production Tax Paid
Extraction Tax Paid
with Report
with Report
Well or Lease Name:
1
2
3
4
A
B
9
14
5
10
15
Oil
Posting
Additional
Transportation
Other
Total Production Tax Due
Total Extraction Tax Due
Gravity
Code
Value
Deduction
Deductions
(5% of Block 4)
(4% or 6.5% of Block 9)
C
D
E
F
G
6
11
16
Production Tax
Extraction Tax
Previously Paid
Previously Paid
API Number:
Sequence #
Condensate
7
12
17
Production Tax Paid
Extraction Tax Paid
By Others
By Others
YES
33 -
(
)
8
13
Production Tax Paid
Extraction Tax Paid
with Report
with Report
Well or Lease Name:
1
2
3
4
A
B
9
14
5
10
15
Oil
Posting
Additional
Transportation
Other
Total Production Tax Due
Total Extraction Tax Due
Gravity
Code
Value
Deduction
Deductions
(5% of Block 4)
(4% or 6.5% of Block 9)
C
D
E
F
G
6
11
16
Production Tax
Extraction Tax
Previously Paid
Previously Paid
API Number:
Sequence #
Condensate
7
12
17
Production Tax Paid
Extraction Tax Paid
YES
By Others
By Others
33 -
(
)
8
13
Production Tax Paid
Extraction Tax Paid
with Report
with Report
Well or Lease Name:
Page Total
Page Total
Sum of Block 13:
Sum of Block 8:
Page of 2