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 SEVERANCE TAX REPORT FOR TRONA (Form 5100)                            Contact Name and Contact Phone #: Enter the name and telephone 
       INSTRUCTIONS (revised 9/2019)                                   number of the person the Department of Revenue may contact 
                                                                       about this report. 
WHO MUST FILE - All taxes on production shall be remitted by            
the operator or his duly authorized agent. Severance taxes are         Production Period: Enter the production period (month and year of 
determined from the gross production in the current calendar year.     the production reported). If you qualify to file annually, report the 
                                                                       production period as December (for example, 12/2000).  
WHEN TO FILE - Severance tax reports and payment in-full                
must  be  postmarked  by  the  25th  day  of  the  second  month       Form Type: Indicate if the report filed is an original (O) or an 
following the month of production. If a taxpayer’s total liability     amended (A) report. Do not report original and amended line items 
for severance tax was less than $30,000 for the preceding calendar     on the same Form 5100. 
year, monthly reporting and payment requirements are waived and         
the taxpayer shall report and pay the tax annually, by February        Mine Group Number: Enter the Mine Group Number (the 5-digit 
25th of the year following the year of production. If a severance      number beginning with a 9) assigned by the Department of Revenue. 
tax report shows tax due, the taxpayer shall pay the tax due when      If you are reporting a mine group which has not been assigned a 
the report is filed. If a taxpayer does not file severance tax reports Mine Group Number, leave this box blank. 
and pay the total tax due by the due date, the severance tax is         
delinquent and is subject to penalty and interest.                     Soda Ash Tons Sold: Enter the tons of soda ash sold to unrelated 
                                                                       parties during the production period.  
FOR ASSISTANCE - For assistance with any Wyoming solid                  
mineral tax question, please call the Mineral Tax Division of the      Soda Ash Sales Value: Enter the sales value (f.o.b. plant) of soda 
Department of Revenue at (307) 777-7935.                               ash sold to unrelated parties during the production period. 
                                                                        
Trona is assessed for mineral taxation purposes in accordance with     Trona Tons Mined: Enter the tons of trona ore mined during the 
Wyoming Statute 39-14-303. For additional information on the           production period.  
valuation  of  trona,  refer  to  Wyoming  Statute  39-14-303  and      
Chapter 6 of the Rules of the Wyoming Department of Revenue.           Taxable Value: Enter the taxable value of the tons of trona ore 
                                                                       mined during the production period. Compute the taxable value in 
GENERAL INSTRUCTIONS - Please complete a Severance                     accordance with Wyoming Statute 39-14-303. 
Tax Report For Trona (Form 5100), using production, sales, and          
taxable value information for the production period reported. IF       Total Tax Due: Enter the result of multiplying the Taxable Value 
YOU ARE A MONTHLY FILER, DO NOT REPORT YEAR-                           by 4%, rounded to 2 decimal places (for example, $100.12). 
TO-DATE TOTALS FOR SODA ASH TONS SOLD, SODA                             
ASH  SALES  VALUE,  TRONA  TONS  MINED,  OR                            Previous Tax Paid (amends): For amended reports only. Report 
TAXABLE  VALUE.  REPORT  ONLY  THE  SODA  ASH                          the severance tax previously paid for this line item. If this is an 
TONS SOLD, SODA ASH SALES VALUE, TRONA TONS                            original report, enter 0. 
MINED, AND    TAXABLE               VALUE          FOR THE              
PRODUCTION  PERIOD  REPORTED.  All  information                        Current Tax Due: Enter the result of subtracting Previous Tax 
provided should be determined on the accrual basis of accounting,      Paid from Total Tax Due. 
in  accordance  with  generally  accepted  accounting  principles.      
Round  all  figures  to  the  nearest  whole  number  except  where    Page Total: Enter the sum of the Current Tax Due column on this 
otherwise instructed. Fill out the report completely, on the forms     Form 5100.  
provided  by  the  Department.  Do  not  substitute  computer           
generated forms. If the report is not filled out completely and        Payment  Amount:  Enter  the  payment  submitted  with  your 
accurately, the report may be considered delinquent and may be         report(s). 
subject to penalty and interest. The sum of the taxable values          
reported on your monthly severance tax reports must equal the          AMENDMENT - Form 5100 is now filed on a monthly basis. 
total taxable value of your trona production for the calendar year.    Year-to-date information is no longer reported on each monthly 
                                                                       severance  report.  Corrections  to  information  reported  may  be 
NOTE: Production, sales, taxable value, and tax due information        implemented  for  each  production  period  by  filing  amended 
must still be reported separately for each mine group, using the       severance reports. Amended reports must be filed in accordance 
Mine Group Number assigned by the Department of Revenue.               with the statute of limitations described in W.S. 39-14-308. Report 
However you may now report information for more than one Mine          the corrected replacement value for Soda Ash Tons Sold, Soda 
Group Number on separate lines of the same Form 5100.                  Ash Sales Value, Trona Tons Mined, and Taxable Value on your 
                                                                       amended reports. Please indicate the Form Type as (A). Do not 
Operator ID: Enter the operator ID number (the 4-digit number          report original and amended line items on the same Form 5100. 
beginning with a 9) assigned to you by the Department of Revenue.       
If an operator ID has not been assigned to you, leave this box blank.  The mailing address for Department of Revenue mineral forms is: 
                                                                                          Wyoming Department of Revenue  
Operator Name: Enter the Operator Name. Do not enter the name                             Mineral Tax Division 
of the contact person or tax agent.                                                       Herschler Building, 3rd Floor East 
                                                                                          Cheyenne, WY  82002-0110 



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State of Wyoming 
Department of Revenue                    SEVERANCE TAX REPORT                                  5100 
122 West 25th Street 
Cheyenne WY 82002-0110                          FOR TRONA                                      *5100* 
         DOR USE ONLY: 
                            
Operator ID:                          Operator Name:                                                                                                               

Contact Name:                                           Contact Phone #:  (         ) 

                                                              O - Original     
Prod. Period:           /                Form Type:           A - Amended 
 MINE            SODA  ASH  SODA  ASH    TRONA TONS  TAXABLE  VALUE TOTAL  TAX  DUE  PREVIOUS                                                            CURRENT 
 GROUP      TONS  SOLD      SALES  VALUE  MINED                                      TAX  PAID                                                           TAX  DUE 
 NUMBER                                                                              (AMENDS) 

                                                                             PAGE TOTAL:                                                                           
 DO NOT REPORT YEAR-TO-DATE INFORMATION                                                       
 REPORT PRODUCTION PERIOD INFORMATION ONLY                                   PAYMENT AMOUNT: 
                                                                                                                                                                   
            I declare under penalty of perjury that I have examined this return and, to the best of my knowledge and belief, it is correct and complete. 

                 Authorized Signature                               Title                                                                                Date 
REV.2/2000 






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