State Form 9931 - Property Schedule For Gas And Oil Well Assessment Page 2

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INSTRUCTIONS FOR ALLOCATION OF INTERESTS:

1. Enter in Column 1 an R for a royalty interest or a W for a working interest.

2. Enter in Column 2 the decimal equivalent for the interest in the entire property (for example, 0.1250 for a 1/8 royalty interest). The entries in this column

should total 1.0000.

3. Enter in Column 3 the decimal equivalent of the partial interest in the particular interest noted in Column 2 (for example, 0.5000 for a 1/2 interest in the

1/8 royalty interest). The entries in this column for a particular interest type (R or W) should total 1.0000.

4. Multiply the interest in Column 3 by the respective assessment subject to allocation and enter the result in Column 4. Note the sum of the entries should

equal the sum of 4D. and 5C.

FORM G & O-1

ALLOCATION OF ROYALTY AND WORKING INTEREST ASSESSMENTS

ASSESSMENT SUBJECT TO ALLOCATION (enter from page 1)

COLUMN

Royalty interest (4D.)

Working interest (5C.)

INTEREST

CALCULATED

OWNER

ADDRESS ( number and street, city, state, and ZIP code)

TYPE

FACTOR

ASSESSMENT

(R or W)

IN PROPERTY

WITHIN TYPE

ACKNOWLEDGMENT AND CERTIFICATION

Under the penalties of perjury, I hereby certify that this schedule to the best of my knowledge and belief is true, correct and complete; and reports the

production and well information under this lease.

Signature

Printed name (type or print)

Date signed (month, day, year)

Address (number and street, city, state, and ZIP code)

NOTARY

STATE OF :

COUNTY OF:

Before me, a notary public in and for said state and county, personally appeared, this ___________day of _________________________, 20 ________, the

owner/operator or a person duly authorized to sign for and on behalf of said lessee, who acknowledged the execution of this return as the voluntary act and

deed of the owner/operator.

Signature of Notary

County of residence

Date commission expires (month, day, year)

Name of Notary (type or print)

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