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Form Atd-39 - Personal Property For Drilling/well Service Workover/seismic Rigs 2003 Page 2

STATE OF WYOMING STATEMENT OF DRILLING / WELL SERVICE / WORK

OVER / SEISMIC RIGS

Owners of drilling, well service, work over, completion & seismic rigs are

required to file this data reporting form no later than March 1, 2004.

RETURN TO:

COUNTY _________________________________________________________________________

ADDRESS_________________________________________________________________________

CITY, STATE, ZIP ___________________________________________________________________

Please fill in all spaces provided. One form is required for each rig owned on

January 1st.

OWNER ________________________________________________________________________

ADDRESS________________________________________________________________________

CITY,STATE,ZIP___________________________________________________________________

OPERATOR ID NO. ___________________________

TELEPHONE NO. (

)

CONTACT PERSON _________________________________

RIG NUMBER _______________ RIG NAME ____________________________ RIG AGE

_________

LEGAL LOCATION AS OF JANUARY 1, 2003 COUNTY _____________________

QUARTER SECTION __________ SECTION __________ TOWNSHIP _______ RANGE ________

ON JANUARY 1st., 2003, THIS RIG WAS [ ] WORKING [ ] IDLE.

NUMBER OF DAYS WORKED IN WYOMING IN THE PAST YEAR ____________

WAS THIS RIG CAPABLE OF COMPLETE AND CONTINUOUS OPERATION AS OF JANUARY 1,

2003

[ ] YES [ ] NO IF NO PLEASE INDICATE WHY ___________________________________

IF STACKED WHAT PERCENT (%) COMPLETE __________________

TYPE OF RIG: [ ] DRILLING [ ] WELL SERVICE [ ] SEISMIC [ ] OTHER

_____________________

IS THIS RIG

[ ] SKID MOUNTED

[ ] WHEEL MOUNTED,

LICENSE # __________ STATE ___ EXP. DATE______

[ ] SELF PROPELLED,

LICENSE # _________ STATE ___ EXP. DATE ______

[ ] TRAILER MOUNTED, LICENSE # __________ STATE ___ EXP. DATE ______

[ ] CARRIER: MAKE & MODEL: ________________________________________

VIN# (VEHICLE IDENTIFICATION NUMBER) ___________________________

DRAWWORKS MAKE: _____________________ MODEL __________________

DEPTH RATING: _____________ FT., [ ] MECHANICAL OR [ ] ELECTRIC

ATD-39

Revised 12/03

Form Atd-39 - Personal Property For Drilling/well Service Workover/seismic Rigs 2003 Page 2