Reauest For Assignment Of Production Unit Number Gross Production Registration Form - Oklahoma Tax Commission

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OTX00320-01-98-OK
320-A-R-98
R
F
A
O
P
U
N
EQUEST
OR
SSIGNMENT
F
RODUCTION
NIT
UMBER
G
P
R
ROSS
RODUCTION
EGISTRATION
Oklahoma Tax Commission
P.O. Box 26920, Oklahoma City, OK 73126-0920
(Please read instructions before completing and print or type information)
F
O
U
O
O
I
OR
FFICE
SE
NLY
PERATOR
NFORMATION:
A.
B.
FEIN/SSN
Operator Number
C.
Entity Name
D.
DBA:
E.
Mailing Address
County
Lease
Sub
Merge
F.
City
State
Zip
Number
Number
Number
Number
Business
G.
H.
Is this a new address? YES
NO
Telephone
L
A
P
I
EASE
ND
RODUCT
NFORMATION
1
2
Lease Name
Well Name/Number
3
County Name
%
County Name
%
4
5
Total Lease Acreage
Lease Legal Description
6
7
API Number
Well Classification Oil
Gas
(Issued by the Corporation Commission)
8
Producing Formation(s)
9
Is/are formation(s) spaced?
YES
NO
(If YES, complete a., b., and c. below)
a. Spaced acreage and legal description
b. Spacing order number
c. Increased density order number
Comments:
a. Product
10
Code
b. Purchaser Name
c. Purchaser Number
d. Tax Remitter Number
e. First Sale
Month
Year
Month
Year
Month
Year
Month
Year
11
Oklahoma Law (O.S. 68, Sec 1009d) requires the first purchaser to remit the tax. OTC approval must be obtained before a operator m
F
O
U
O
OR
FFICE
SE
NLY
Operator's request
Approved
Denied
By
Date
12
I declare under penalty of perjury that to the best of my knowledge the above information is true and correct. I also understand that production may not be
removed from this lease until OTC has approved and distributed this application to all parties involved, and I must submit a change form when any of the above
information changes.
sign
Date
here
Type or print name and title
Signature
OTC will provide a copy of this form to all involved companies

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