Form 320-A - Request For Assignment Of Production Unit Number Gross Production Registration - 2011

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Form 320-A
Request for Assignment of Production Unit Number
Revised 6-2011
Gross Production Registration
Oklahoma Tax Commission
Post Office Box 26920, Oklahoma City, OK 73126-0920
(Please read instructions before completing and print or type information)
Go to for Gross Production Tax Rates
Operator Information
For Office Use Only
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 ________________
Lease and Product Information
1.
2.
Lease Name __________________________________________
Well Name/Number ____________________________
3.
4.
Incentive Code __________________________
Incentive Qualifying Date: Month ________________ Year ___________
5.
County Name _______________________
% ____________ County Name ______________________
% __________
6.
7.
Total Lease Acreage ________________________________
Lease Legal Description ____________________________
________________________________________________________________________________________________________
8.
Surface hole legal description for horizontal well ______________________________________________________________
9.
Bottom hole legal description for horizontal well _______________________________________________________________
10.
11.
API Number ______________________________________
Well Classification:
Oil ___________
Gas __________
12.
Producing Formation(s) _________________________________________________________________________________
____________________________________________________________________________________________________
13.
Is/are formation(s) spaced:
Yes
No
(If Yes, complete a., b., and c. below)
a.
Spaced acreage and legal description ___________________________________________________________________
____________________________________________________________________________________________________
b.
c.
Spacing order number _______________________
Increased density order number _________________________
Comments: __________________________________________________________________________________________
____________________________________________________________________________________________________
14.
a. Product Code
b. Purchaser Name
c. Purchaser Number
d. Tax Remitter Number
e. First Sale
____________
__________________________
__________________
_____________________
Month ______ Year ______
____________
__________________________
__________________
_____________________
Month ______ Year ______
____________
__________________________
__________________
_____________________
Month ______ Year ______
____________
__________________________
__________________
_____________________
Month ______ Year ______
15. Provide reason for requesting the operator or interest owner to remit taxes:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
For Office Use Only
Operator’s Request:
Approved
Denied By _________ Date ______________
16.
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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