Form R-9051 "Oilfield Site Restoration Fee Return - Natural Gas Production" - Louisiana

What Is Form R-9051?

This is a legal form that was released by the Louisiana Department of Revenue - a government authority operating within Louisiana. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Louisiana Department of Revenue;
  • 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 R-9051 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Revenue.

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Download Form R-9051 "Oilfield Site Restoration Fee Return - Natural Gas Production" - Louisiana

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R-9051 (7/18)
If your name has
If amended return,
If final return,
O
O
O
changed, fill in circle.
fill in circle.
fill in circle.
Account Number:
Oilfield Site Restoration Fee
Name (1):
Return - Natural Gas Production
Name (2):
Louisiana Department of Revenue
P.O. Box 201
Address (1):
Baton Rouge, LA 70821-0201
Phone: (855) 307-3893
Address (2):
City, State ZIP:
Fie ld fla g
FOR OFFICE USE ONLY.
Taxable Period (mm/yy)
NG
Fee rate
MCFs
Amount of fee
Category
per MCF
(Thousand Cubic Feet)
(Round to the nearest dollar)
Full rate (Severance tax rate codes 1, D,
X
.003
00
1
1a
1b
H, I, IA, OW, and T)
X
2
2a
.0012
2b
00
Incapable oil well gas
X
.000525
00
3
Incapable gas well gas
3a
3b
4
4
00
Total fees (Add Lines 1b, 2b, and 3b)
5
5
00
Interest (See instructions)
00
6
Delinquent penalty (5% for each 30 days or fraction thereof, not to exceed 25% of Line 4)
6
Total fees, interest, and penalty due (Add Lines 4, 5, and 6)
7
7
00
Make payment payable to: Louisiana Department of Revenue. DO NOT SEND CASH. Pay this amount.
This return is due on or before the 25th 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 legal holiday, the return is due the next business day and becomes delinquent the first day
thereafter.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature
Date
(mm/dd/yyyy)
Print Name
Title
Telephone
Print/Type Preparer’s Name
Preparer’s Signature
Date
(mm/dd/yyyy)
Check
if Self-employed
PAID
PREPARER
Firm’s Name
Firm’s FEIN
USE ONLY
Firm’s Address
Telephone
Complete only if change in business status has occurred.
Date business discontinued
Date business sold
Name of purchaser
(mm/dd/yyyy)
(mm/dd/yyyy)
PTIN, FEIN, or LDR Account Number
of Paid Preparer
For office
use only.
5420
R-9051 (7/18)
If your name has
If amended return,
If final return,
O
O
O
changed, fill in circle.
fill in circle.
fill in circle.
Account Number:
Oilfield Site Restoration Fee
Name (1):
Return - Natural Gas Production
Name (2):
Louisiana Department of Revenue
P.O. Box 201
Address (1):
Baton Rouge, LA 70821-0201
Phone: (855) 307-3893
Address (2):
City, State ZIP:
Fie ld fla g
FOR OFFICE USE ONLY.
Taxable Period (mm/yy)
NG
Fee rate
MCFs
Amount of fee
Category
per MCF
(Thousand Cubic Feet)
(Round to the nearest dollar)
Full rate (Severance tax rate codes 1, D,
X
.003
00
1
1a
1b
H, I, IA, OW, and T)
X
2
2a
.0012
2b
00
Incapable oil well gas
X
.000525
00
3
Incapable gas well gas
3a
3b
4
4
00
Total fees (Add Lines 1b, 2b, and 3b)
5
5
00
Interest (See instructions)
00
6
Delinquent penalty (5% for each 30 days or fraction thereof, not to exceed 25% of Line 4)
6
Total fees, interest, and penalty due (Add Lines 4, 5, and 6)
7
7
00
Make payment payable to: Louisiana Department of Revenue. DO NOT SEND CASH. Pay this amount.
This return is due on or before the 25th 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 legal holiday, the return is due the next business day and becomes delinquent the first day
thereafter.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature
Date
(mm/dd/yyyy)
Print Name
Title
Telephone
Print/Type Preparer’s Name
Preparer’s Signature
Date
(mm/dd/yyyy)
Check
if Self-employed
PAID
PREPARER
Firm’s Name
Firm’s FEIN
USE ONLY
Firm’s Address
Telephone
Complete only if change in business status has occurred.
Date business discontinued
Date business sold
Name of purchaser
(mm/dd/yyyy)
(mm/dd/yyyy)
PTIN, FEIN, or LDR Account Number
of Paid Preparer
For office
use only.
5420