Form 320-C-R-8-1999 - Gross Production Request For Change

OTX00321C-08-99-OK

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Oklahoma Tax Commission

GROSS PRODUCTION REQUEST FOR CHANGE

P.O. Box 26920

(Please read instructions before completing and print or type information)

Oklahoma City, OK 73126-0920

Office Use Only

Part I:

Operator Information

A

Check one box:

Operator

Interest Owner

FEIN/SSN

B

C

Operator Number/Interest Owner

County

Lease

Sub

Merge

D

Name of Operator/Interest Owner

Number

Number

Number

Number

%

E

Mailing Address

Exempt

Decimal

City

State

Zip

F

Code

Equivalent

Business Phone

Is this a new address? YES

NO

G

H

Part II:

Production Unit Number/Well Name

B

A

Production unit number

Well name

Check appropriate box below and complete Section IV.

1.

Cancel product code(s)

C

2.

Cancel production unit number (explain in reasons below , Part V, Section B)

3.

Change of operator - is this a change of ownership of equipment?

Yes

No

Complete sections three and four.

4.

Cancel or add purchaser

5.

Change of producing formation/legal description

Lease legal description

Name of formation/spacing order

E

D

Part III

A

B

C

Name of former operator

FEIN/SSN

Former operator number

Effective date of change

Part IV:

Product and Purchaser Change Information

(Obtain product code number from general instructions or specific instructions on reverse and list purchasers you will be selling to)

G

A.

D.

Date

E.

A

B

C

D

E

F

Tax Remitter

Effective

Prod.

Purchaser

Interest

Mo.

Year

Code

Purchaser Name

Number

Add

Cancel

Purchaser

Operator

Owner

Part V

If operator or interest owner requests to remit production taxes, please provide reason

A

B

Reasons for cancel or suspension

Effective Date:

C

Comments:

D

Part VI:

For Office Use Only

R R R R e e e e q q q q u u u u e e e e s s s s t t t t f f f f o o o o r r r r o o o o p p p p e e e e r r r r a a a a t t t t o o o o r r r r / / / / i i i i n n n n t t t t e e e e r r r r e e e e s s s s t t t t o o o o w w w w n n n n e e e e r r r r t t t t o o o o r r r r e e e e m m m m i i i i t t t t t t t t a a a a x x x x e e e e s s s s i i i i s s s s

A A A A p p p p p p p p r r r r o o o o v v v v e e e e d d d d

D D D D e e e e n n n n i i i i e e e e d d d d

B B B B y y y y

D D D D a a a a t t t t e e e e

Part VII

I declare under penalty of perjury that to the best of my knowledge the above information is true and correct.

sign

here

Date

Type or print name and title

Signature

The Oklahoma Tax Commission will provide a copy of this form to all involved companies