1
2
Description of the Property
(a separate report must be filed for each property)
3
Parcel Number
Tax Rate Area
4
Phone Number
6
Year's Total
7
Name of Energy Buyer
8
Date of Sales Contract
9
Contract Basis
10
Lien Date Price/Unit
11
Is this a Pilot Project?
12
Proved Reserves
As of year end
Developed
Undeveloped
13
Describe Company Method of Computing Reserve Estimates
14
Change of Ownership (working interest only)
a. Has there been a change of ownership in the working interest of this property since January 1 last year?
b. Was this change of ownership in the working interest a partial or divided interest?
c. If so, what was the percentage that transferred
d. Name or names of new owners
Address
15
Remarks
