North Dakota Form T 12 PDF Details

Are you a resident of North Dakota looking to file your taxes? Have you come across the mysterious and often confusing Form T 12 from the Tax Commissioner? Understanding tax forms can be tricky, so we’re here to break it down for you. You’ll learn what exactly the purpose of this form is, when and why it needs to be completed, and who needs to use it! Read on for all the details about North Dakota's Form T 12.

QuestionAnswer
Form NameNorth Dakota Form T 12
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namest12 oil north dakota t12 form

Form Preview Example

 

 

 

NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER

 

 

 

600 E. BOULEVARD AVE., BISMARCK, ND 58505-0599

 

 

OIL GROSS PRODUCTION AND OIL EXTRACTION TAX REPORT

 

 

 

 

 

 

 

ORIGINAL

 

PRODUCER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Check One)

 

(Check One)

 

 

 

 

 

 

 

 

YEAR/MONTH

 

 

 

 

 

AMENDED

 

PURCHASER

 

 

 

 

 

 

 

 

 

 

(i.e., 1999, 2000)

(i.e., 01, 12)

 

 

FEDERAL I.D. NUMBER

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

PHONE

CITY

 

 

 

 

 

STATE/PROV.

 

 

ZIP CODE

FORM T-12

(August 2000)

For Office Use Only

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 ………………….….…………….…………...…………

2. Penalty on Gross Production Tax ………………………… (See Instructions)…………….....………

3. Interest on Late Gross Production Tax …………..…….… (See Instructions)………………..………

4. Total Due ……...…… (Add Lines 1, 2, and 3) …………………..……………………………………………...…………..……………………

Line 1 - Total from

Block 8 on T-12

Worksheet

OIL EXTRACTION TAX

5.Oil Extraction Tax Paid With Report ……………...…………………...……………………………

6.Penalty on Oil Extraction Tax ……………………………… (See Instructions)……………..…………

7.Interest on Late Oil Extraction Tax …………...…………… (See Instructions)…..…………….………

8.Total Due …..……… (Add Lines 5, 6, and 7) ……………………………..…………………………...……………………………………

Line 5 - Total from Block 13 on T-12 Worksheet

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 Oil

 

Value of Exempt

Taxable Value of Oil

Pool

Well

 

Taxable Value of Oil

Other Party

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oil

 

Posting

Additional

Transportation

Other

 

Total Production Tax Due

5

Total Extraction Tax Due

10

 

15

 

 

Gravity

 

Code

Value

 

Deduction

Deductions

 

(5% of Block 4)

 

(4% or 6.5% of Block 9)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

D

E

F

 

 

G

 

Production Tax

6

Extraction Tax

11

 

16

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previously Paid

 

Previously Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

API Number:

 

 

 

 

Sequence #

Condensate

 

Production Tax Paid

7

Extraction Tax Paid

12

 

17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

-

 

 

(

)

YES

 

By Others

 

By Others

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Production Tax Paid

8

Extraction Tax Paid

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well or Lease Name:

 

 

 

 

 

 

with Report

 

with Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

2

 

 

 

 

3

4

A

B

9

 

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oil

 

Posting

Additional

Transportation

Other

 

Total Production Tax Due

5

Total Extraction Tax Due

10

 

15

 

 

Gravity

 

Code

Value

 

Deduction

Deductions

 

(5% of Block 4)

 

(4% or 6.5% of Block 9)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

D

E

F

 

 

G

 

Production Tax

6

Extraction Tax

11

 

16

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previously Paid

 

Previously Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

API Number:

 

 

 

 

Sequence #

Condensate

 

Production Tax Paid

7

Extraction Tax Paid

12

 

17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

-

 

 

(

)

YES

 

By Others

 

By Others

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Production Tax Paid

8

Extraction Tax Paid

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well or Lease Name:

 

 

 

 

 

 

with Report

 

with Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

2

 

 

 

 

3

4

A

B

9

 

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oil

 

Posting

Additional

Transportation

Other

 

Total Production Tax Due

5

Total Extraction Tax Due

10

 

15

 

 

Gravity

 

Code

Value

 

Deduction

Deductions

 

(5% of Block 4)

 

(4% or 6.5% of Block 9)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

D

E

F

 

 

G

 

Production Tax

6

Extraction Tax

11

 

16

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previously Paid

 

Previously Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

API Number:

 

 

 

 

Sequence #

Condensate

 

Production Tax Paid

7

Extraction Tax Paid

12

 

17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

-

 

 

(

)

YES

 

By Others

 

By Others

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Production Tax Paid

8

Extraction Tax Paid

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well or Lease Name:

 

 

 

 

 

 

with Report

 

with Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page Total

 

Page Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sum of Block 8:

 

Sum of Block 13: