DOR Taxation web site

Withholding Statements

Withholding agents are responsible for completing by March 1 of each year an Oil and Gas Withholding Statement (DR 0021W) for each interest owner from whom you have withheld.

On the Oil and Gas Withholding Statement, you must provide for the entire calendar year:


1. Gross disbursements made to the interest owner.
2. Total amount of severance tax withheld from the gross income payments disbursed to the interest owner.
3. Total amount of the interest owner's share of any ad valorem taxes.


Copies of the Oil and Gas Withholding Statement (DR 0021W) are available from the department upon request. This form consists of four self-carbon copies. Retain two copies for your records. Mail two copies to the interest owner by March 1 of the year following the calendar year covered by the statement.


If you prefer to print computer facsimiles of the Oil and Gas Withholding Statement (DR 0021W), you may do so provided that all the information requested on the form is included and sufficient copies are made for distribution to interest owners and the Department of Revenue.