PDF document
- 1 -
 SEVERANCE TAX REPORT FOR URANIUM (Form 5200)                          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 5200. 
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.                     Lbs.  Sold:  Enter  the  pounds  of  yellow  cake  sold  during  the 
                                                                       production period. 
FOR ASSISTANCE - For assistance with any Wyoming solid                  
mineral tax question, please call the Mineral Tax Division of the      Sales Value: Enter the sales value of yellow cake sold during the 
Department of Revenue at (307) 777-7935.                               production period. 
                                                                        
Uranium is assessed for mineral taxation purposes in accordance        Lbs. Produced: Enter the pounds of uranium produced during the 
with Wyoming Statute 39-14-503. For additional information on          production period. 
the valuation of uranium, refer to Wyoming Statute 39-14-503 and        
Chapter 6 of the Rules of the Wyoming Department of Revenue.           Taxable Value: Enter the taxable value of the pounds of uranium 
                                                                       produced during the production period. Compute the taxable value 
GENERAL INSTRUCTIONS - Please complete a Severance                     in accordance with Wyoming Statute 39-14-503. 
Tax Report For Uranium (Form 5200), using production, sales,            
and taxable value information for the production period reported.      Total Tax Due: Enter the result of multiplying the Taxable Value 
IF YOU ARE A MONTHLY FILER, DO NOT REPORT                              by the severance tax rate for the production period, rounded to 2 
YEAR-TO-DATE  TOTALS  FOR  YELLOW  CAKE  LBS.                          decimal places (for example, $100.12). 
SOLD, SALES VALUE, URANIUM LBS. PRODUCED, OR                            
TAXABLE VALUE. REPORT ONLY THE YELLOW CAKE                             Previous Tax Paid (amends): For amended reports only. Report 
LBS. SOLD, SALES VALUE, URANIUM LBS. PRODUCED,                         the severance tax previously paid for this line item. If this is an 
AND  TAXABLE  VALUE  FOR  THE  PRODUCTION                              original report, enter 0. 
PERIOD  REPORTED.  All  information  provided  should  be               
determined on the accrual basis of accounting, in accordance with      Current Tax Due: Enter the result of subtracting Previous Tax 
generally accepted accounting principles. Round all figures to the     Paid from Total Tax Due. 
nearest whole number except where otherwise instructed. Fill out        
the report completely, on the forms provided by the Department.        Page Total: Enter the sum of the Current Tax Due column on this 
Do not substitute computer generated forms. If the report is not       Form 5200.  
filled out completely and accurately, the report may be considered      
delinquent and may be subject to penalty and interest. The sum of      Payment  Amount:  Enter  the  payment  submitted  with  your 
the taxable values reported on your monthly severance tax reports      report(s). 
must equal the total taxable value of your uranium production for       
the calendar year.                                                     AMENDMENT - Form 5200 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. 39-14-508. Report 
Group Number on separate lines of the same Form 5200.                  the corrected replacement value for Yellow Cake Lbs. Sold, Sales 
                                                                       Value,  Uranium  Lbs.  Produced,  and  Taxable  Value  on  your 
Operator ID: Enter the operator ID number (the 4-digit number          amended reports. Please indicate the Form Type as (A). Do not 
beginning with a 9) assigned to you by the Department of Revenue.      report original and amended line items on the same Form 5200. 
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 



- 2 -
State of Wyoming 
Department of Revenue                     SEVERANCE TAX REPORT                                     5200 
122 West 25th Street 
Cheyenne WY 82002-0110                          FOR URANIUM                                        *5200* 
         DOR USE ONLY: 
                             
Operator ID:                          Operator Name:                                                                                                               

Contact Name:                                              Contact Phone #:  (         ) 

                                                                  O - Original     
Prod. Period:           /                 Form Type:              A - Amended 
 MINE            LBS.  SOLD  SALES  VALUE LBS.  PRODUCED 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 






PDF file checksum: 1768150894

(Plugin #1/8.13/12.0)