Form 2014 Report of Sales and Royalty Remittance

1

REPORT OF SALES AND ROYALTY REMITTANCE
FORM MMS-2014

OMB Control Number 1012-0004
OMB Approval Expires 12/31/2012

PAYOR NAME: _____________________________________

API WELL NUMBER

MMS
AGREEMENT NUMBER

11

12

13

14

15

ADJUSTMENT
REASON CODE

9

8

10
MMS
LEASE NUMBER

PRODUCT
CODE

7
RESERVED FOR
PREPARER’S USE

TRANSACTION
CODE

6

SALES
MO/YR
(MMCCYY)

5

4 PAYOR-ASSIGNED
DOCUMENT NUMBER __ __ __ __ __ __ __ __

SALES
TYPE CODE

PAYOR CODE: __ __ __ __ __

LINE NUMBER

2

For
MMS
Use
Only

(F or I)

3 FEDERAL/INDIAN REPORT INDICATOR

16
SALES VOLUME
(Mcf/bbl/gal/long ton)

19

ROYALTY VALUE
PRIOR TO ALLOWANCES
$

17
GAS MMBtu

20

TRANSPORTATION
ALLOWANCE
DEDUCTION $

18
SALES VALUE
$

21

22

PROCESSING
ALLOWANCE
DEDUCTION $

INTENTIONALLY
LEFT
BLANK
ROYALTY VALUE
LESS ALLOWANCES
$

23
PAYMENT
METHOD CODE

U.S. DEPARTMENT OF THE INTERIOR
Office of Natural Resources Revenue

1

2

3

4

Authorized Name (print) and Signature

Date

If company contact information has changed, please indicate below: (Please print)

Contact Name
Street
City
Fax Number
Form MMS-2014 (revised 12/2009)

Phone Number
P.O. Box

Suite or Other Identifier

State

Zip Code
Email Address

PAYMENT INFORMATION

I have read and examined the statements in this report and agree they are accurate and complete.

Checks To MMS (PM1)
________________
*Indian Direct Pay (PM2)
________________
EFT Payments (PM3)
________________
*Royalty-In-Kind (PM4)
________________
Checks To MMS For BIA (PM5)
________________
Other (For Future Use) (PM6)
________________
*Indian Lockbox (PM7)
________________
Total All Payments:
________________
=
Less Available Credits: (*Credits may not be applied to PM2, PM4, PM7)
Doc. ID: _________________
_______________
Doc. ID: _________________
________________
Doc. ID: _________________
________________
Net Payment for this Report:
= ________________
$

PAGE
TOTAL
REPORT
TOTAL

PAGE ____ OF _____

REPORT OF SALES AND ROYALTY REMITTANCE
FORM MMS-2014

INSTRUCTIONS
This form is used to report royalties and other obligations due on Federal and Indian oil
and gas, and geothermal leases. For detailed instructions and examples on how to
complete and submit this form, please refer to the Minerals Revenue Reporter Handbook.
If you need to speak with someone about your reporting, call 1 (800) 525-0309 or
1 (800) 525-7922.
Send completed Form MMS-2014 to:
Office of Natural Resources Revenue
P.O. Box 25627
Denver, Colorado 80225-0627
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to
inform you that we collect this information to document details of royalty payments and sales of minerals
from leases on Federal and Indian lands. The MMS uses the information to maintain and audit lease
accounts. Responses are mandatory (43 U.S.C. 1334). Proprietary information is protected in accordance
with standards established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733),
the Freedom of Information Act [5 U.S.C. 552(1), (4)], and Department regulations (43 CFR 2). An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB Control Number. The public reporting burden for this form is estimated to
average 3 minutes per line for electronic reporting and 7 minutes per line for manual reporting. These
estimates include the time for reviewing instructions, gathering and maintaining data, and completing and
reviewing the form. Direct any comments regarding the burden estimate or any other aspect of this form to
the Office of Natural Resources Revenue, Attention: Rules & Regs Team, P.O. Box 25165, Denver, CO
80225-0165.