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 SEVERANCE TAX REPORT FOR UNDERGROUND COAL                                 Form Type: Indicate if the report filed is an original (O) or an amended 
 (Form 5010) INSTRUCTIONS (revised 9/2019)                                 (A) report. Do not report original and amended line items on the same 
                                                                           Form 5010. 
WHO MUST FILE - All taxes on production shall be remitted by the            
operator or his duly authorized agent. Severance taxes are determined      Mine Group Number: Enter the Mine Group Number (the 5-digit number 
from the gross production in the current calendar year.                    beginning with a 9) for each line item reported, as assigned by the 
                                                                           Department of Revenue. If you are reporting a mine group which has not 
WHEN TO FILE - Severance tax reports and payment in-full must be           been assigned a Mine Group Number, leave this box blank. 
postmarked by the 25th day of the second month following the month          
of production. If a taxpayer’s total liability for severance tax was less  Rate Code: Enter the proper Rate Code for each line item reported. The 
than $30,000 for the preceding calendar year, monthly reporting and        Rate Code for coal subject to the 3.75% severance tax rate is “BAS”. The 
payment requirements are waived and the taxpayer shall report and pay      Rate Code for coal which qualifies for the $.30 severance tax per ton 
the tax annually, by February 25th of the year following the year of       limitation is “30C”. A line item with the “BAS” Rate Code must be filed 
production. If a severance tax report shows tax due, the taxpayer shall    for each Mine Group Number. A separate line item with the “30C” Rate 
pay the tax due when the report is filed. If a taxpayer does not file      Code may be filed for each Mine Group Number with production which 
severance tax reports and pay the total tax due by the due date, the       qualifies for the $.30 severance tax per ton limitation. Do not include the 
severance tax is delinquent and is subject to penalty and interest.        production,  sales,  or  taxable  value  of  $.30  coal  in  the  information 
                                                                           reported under the “BAS” Rate Code. Rate Code “30C” may only be filed 
FOR ASSISTANCE - For assistance with any Wyoming solid mineral             by those producers with coal production sold under contracts which 
tax question, please call the Mineral Tax Division of the Department of    qualify for the $.30 severance tax per ton limitation allowed under 
Revenue at (307) 777-7935.                                                 Wyoming Statute 39-14-105(b). Producers must submit a letter to the 
                                                                           Department for each coal sales agreement which you think qualifies for 
Coal  is  assessed  for  mineral  taxation  purposes  in  accordance  with the $.30 severance tax per ton limitation. 
Wyoming  Statute  39-14-103.  For  additional  information  on  the         
valuation of coal, refer to Wyoming Statute 39-14-103 and Chapter 6        Tons Sold: Enter the tons of coal sold during the production period.  
of the Rules of the Wyoming Department of Revenue.                          
                                                                           Sales Value: Enter the sales value of coal sold during the production 
GENERAL INSTRUCTIONS - Please complete a Severance Tax                     period. 
Report For Underground Coal (Form 5010), using production, sales,           
and taxable value information for the production period reported.   IF     Tons  Mined:  Enter  the  tons  of  coal  mined  during  the  production 
YOU ARE A MONTHLY FILER, DO NOT REPORT YEAR-TO-                            period.  
DATE  TOTALS  FOR  TONS  SOLD,  SALES  VALUE,  TONS                         
MINED OR TAXABLE VALUE. REPORT ONLY THE TONS                               Taxable Value: Enter the taxable value of the tons of coal mined during 
SOLD, SALES VALUE, TONS MINED AND TAXABLE VALUE                            the production period. Compute the taxable value in accordance with 
FOR THE PRODUCTION PERIOD REPORTED. All information                        Wyoming Statute 39-14-103. 
provided should be determined on the accrual basis of accounting, in        
accordance with generally accepted accounting principles. Round all        Total Tax Due: For Rate Code “BAS”, enter the result of multiplying 
figures to the nearest whole number except where otherwise instructed.     the Taxable Value by 3.75%, rounded to 2 decimal places (for example, 
Fill  out  the  report  completely,  on  the  forms  provided  by  the     $100.12). For Rate Code “30C”, enter the result of multiplying the 
Department. Do not substitute computer generated forms. If the report      Tons Mined by $.30, rounded to 2 decimal places. 
is  not  filled  out  completely  and  accurately,  the  report  may  be    
considered delinquent and may be subject to penalty and interest. The      Previous Tax Paid (amends): For amended reports only. Report the 
sum of the taxable values reported on your monthly severance tax           severance tax previously paid for this Mine Group Number and Rate 
reports must equal the total taxable value of your coal production for     Code. If this is an original report, enter 0. 
the calendar year.                                                          
                                                                           Current Tax Due: Enter the result of subtracting Previous Tax Paid 
NOTE: Production, sales, taxable value, and tax due information must       from Total Tax Due. 
still  be  reported  separately  for  each  mine,  using  the  Mine  Group  
Number assigned by the Department of Revenue. However you may              Page Total: Enter the sum of the Current Tax Due column on this Form 
now report information for more than one Mine Group Number on              5010.  
separate lines of the same Form 5010. You may also report information       
on  production  which  qualifies  for  the  $.30  severance  tax  per  ton Payment Amount: Enter the payment submitted with your report(s). 
limitation on a separate line of the same form with your information on     
production subject to the 3.75% severance tax rate.                        AMENDMENT - Form 5010 is now filed on a monthly basis. Year-to-
                                                                           date information is no longer reported on each monthly severance 
Operator ID: Enter the operator ID number (the 4-digit number beginning    report. Corrections to information reported may be implemented for 
with a 9) assigned to you by the Department of Revenue. If an operator     each production period by filing amended severance reports. Amended 
ID has not been assigned to you, leave this box blank.                     reports must be filed in accordance with the statute of limitations 
                                                                           described in W.S. 39-14-108. Report the corrected replacement value 
Operator Name: Enter the Operator Name. Do not enter the name of the       for Tons Sold, Sales Value, Tons Mined, and Taxable Value on your 
contact person or tax agent.                                               amended reports. Please indicate the Form Type as (A). Do not report 
                                                                           original and amended line items on the same Form 5010. 
Contact Name and Contact Phone #: Enter the name and phone number           
of the person the Department of Revenue may contact about this report.     The mailing address for all Department of Revenue mineral forms is: 
                                                                                      Wyoming Department of Revenue  
Production Period: Enter the production period (month and year of the                 Mineral Tax Division 
production  reported).  If  you  qualify  to  file  annually,  report  the            Herschler Building, 3rd Floor East 
production period as December (for example, 12/2000).                                 Cheyenne, WY  82002-0110 



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State of Wyoming 
Department of Revenue                         SEVERANCE TAX REPORT                                 5010 
122 West 25th Street 
Cheyenne WY 82002-0110                FOR           UNDERGROUND COAL                               *5010* 
         DOR USE ONLY: 
                        
Operator ID:                          Operator Name:                                                                                                               

Contact Name:                                                      Contact Phone #:  (         ) 

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

         BAS                                                                                                                                              

                                                                                 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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