Form 329 - Gross Production Application For Certification Economically At-Risk Oil Lease Form

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Form 329
Certification Number
Revised February 1998
Gross Production Application for Certification
Economically At-Risk Oil Lease
Oklahoma Tax Commission
2501 North Lincoln Blvd.
Oklahoma City, Oklahoma 73194
1.
Operator FEI or SSN
2.
Operator Reporting Number
3.
Operator Name
Address
City, State, Zip
4.
Lease Name
Legal:Section
Township
Range
5.
OTC Assigned Production Unit Number
6.
Calendar Year Applied for
7.
Gross Revenue for the Calendar Year
8.
Lease Royalty
9.
Operating Expenses
10.
Gross Production Taxes
11.
Overhead Cost
12.
Lease Expenses (total of lines 8,9,10, and 11)
13.
Lease Net Profit or Loss (subtract line 12 from line 7)
Note:
If line 13 reflects a loss, or a profit that is less than line 10, then the oil lease is deemed At-Risk.
(See Title 68, Supp. 1996, Section 1001.3)
14.
Affidavit
I, the undersigned, swear (or affirm) that the information set out above is true and correct.
Signature
Title
Subscribed and sworn before a Notary Public in and for said county and state this
day of
, 19
.
County
State
Notary
My Commission Expires

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