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       SEVERANCE TAX REPORT FOR BENTONITE                              Contact Name and Contact Phone #: Enter the name and telephone 
       (Form 5300) 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 5300. 
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.                     Tons Sold: Enter the tons of bentonite sold for taconite, foundry, 
                                                                       or drilling mud applications during the production period. Report 
FOR ASSISTANCE - For assistance with any Wyoming solid                 both bulk and bagged tons sold. 
mineral tax question, please call the Mineral Tax Division of the       
Department of Revenue at (307) 777-7935.                               Sales Value: Enter the sales value of bentonite sold for taconite, 
                                                                       foundry,  or  drilling  mud  applications  during  the  production 
Bentonite is assessed for mineral taxation purposes in accordance      period. Report the sales value net of the packaging premium. 
with Wyoming Statute 39-14-403. For additional information on           
the valuation of bentonite, refer to Wyoming Statute 39-14-403         Wet Tons Mined: Enter the tons of bentonite mined during the 
and  Chapter  6  of  the  Rules  of  the  Wyoming  Department  of      production period. Report the tons mined in wet tons. 
Revenue.                                                                
                                                                       Taxable  Value:  Enter  the  taxable  value  of  the  wet  tons  of 
GENERAL INSTRUCTIONS - Please complete a Severance                     bentonite  mined  during  the  production  period.  Compute  the 
Tax Report For Bentonite (Form 5300), using production, sales,         taxable value in accordance with Wyoming Statute 39-14-403. 
and taxable value information for the production period reported.       
IF YOU ARE A MONTHLY FILER, DO NOT REPORT                              Total Tax Due: Enter the result of multiplying the Taxable Value 
YEAR-TO-DATE  TOTALS  FOR  TONS  SOLD,  SALES                          by 2%, rounded to 2 decimal places (for example, $100.12). 
VALUE,  WET  TONS  MINED,  OR  TAXABLE  VALUE.                          
REPORT ONLY THE TONS SOLD, SALES VALUE, WET                            Previous Tax Paid (amends): For amended reports only. Report 
TONS  MINED,  AND  TAXABLE  VALUE  FOR  THE                            the severance tax previously paid for this line item. If this is an 
PRODUCTION  PERIOD  REPORTED.  All  information                        original report, enter 0. 
provided should be determined on the accrual basis of accounting,       
in  accordance  with  generally  accepted  accounting  principles.     Current Tax Due: Enter the result of subtracting Previous Tax 
Round  all  figures  to  the  nearest  whole  number  except  where    Paid from Total Tax Due. 
otherwise instructed. Fill out the report completely, on the forms      
provided  by  the  Department.  Do  not  substitute  computer          Page Total: Enter the sum of the Current Tax Due column on this 
generated forms. If the report is not filled out completely and        Form 5300.  
accurately, the report may be considered delinquent and may be          
subject to penalty and interest. The sum of the taxable values         Payment  Amount:  Enter  the  payment  submitted  with  your 
reported on your monthly severance tax reports must equal the          report(s). 
total taxable value of your bentonite production for the calendar       
year.                                                                  AMENDMENT - Form 5300 is now filed on a monthly basis. 
                                                                       Year-to-date information is no longer reported on each monthly 
NOTE: Production, sales, taxable value, and tax due information        severance  report.  Corrections  to  information  reported  may  be 
must still be reported separately for each mine group, using the       implemented  for  each  production  period  by  filing  amended 
Mine Group Number assigned by the Department of Revenue.               severance reports. Amended reports must be filed in accordance 
However you may now report information for more than one Mine          with the statute of limitations described in W.S. 39-14-408. Report 
Group Number on separate lines of the same Form 5300.                  the corrected replacement value for Tons Sold, Sales Value, Wet 
                                                                       Tons Mined, and Taxable Value on your amended reports. Please 
Operator ID: Enter the operator ID number (the 4-digit number          indicate  the  Form  Type  as  (A).  Do  not  report  original  and 
beginning with a 9) assigned to you by the Department of Revenue.      amended line items on the same Form 5300. 
If an operator ID has not been assigned to you, leave this box blank.   
                                                                       The mailing address for Department of Revenue mineral forms is: 
Operator Name: Enter the Operator Name. Do not enter the name           Wyoming Department of Revenue - 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                                       5300 
122 West 25th Street 
Cheyenne WY 82002-0110                     FOR BENTONITE                                         *5300* 
         DOR USE ONLY: 
                        
Operator ID:                          Operator Name:                                                                                                               

Contact Name:                                            Contact Phone #:  (         ) 

                                                                O - Original     
Prod. Period:           /             Form Type:                A - Amended 
 MINE       TONS   SOLD SALES  VALUE  WET  TONS  MINED TAXABLE  VALUE TOTAL  TAX  DUE  PREVIOUS                                                          CURRENT 
 GROUP                                                                                 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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