Form Atd40 - Oil & Gas Field Equipment Personal Property-Owned Declaration Schedule For 2013 Page 2

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Form ATD40
State of Wyoming,
Page
OIL & GAS FIELD EQUIPMENT
PERSONAL PROPERTY—OWNED
DECLARATION SCHEDULE FOR 2013
County Number
Parcel #
Act Number
Personal Prop. Type
DO NOT USE - FOR ASSESSORS USE ONLY
Date received:
By:
Name and address of personal property listed here: (please make any corrections here)
Please indicate location of personal property: (please make any changes here)
1/4 __________ 1/4 __________ Section __________ Township __________ Range __________
Type of land this personal property is located on: (check one) [
]
Private
[
]
Public
Please complete the following information about the oil field equipment you own. Must be submitted into
NAICS CODE:___________________
the Assessor’s Office by no later than March 1.
Operator ID #
Contact Person
API Number
Unit Name
Group Number
Field Name
Basin
Well Type
[
] Gas
[
] Oil
[
] CBM
[
] Inj
Well Status
[ ] Producing [ ] shut In [
] Permanently Abandoned [ ] Temporarily Abandoned [ ] Equipment in place [ ] Equipment removed
Please list only one location per form. Do not report depreciated costs. Please do include freight & all installation costs (use additional pages if necessary)
Oil and / or Gas Field Equipment Description
Model
Units or Footage
Size
Pressure
Condition
Year
Installed
(include all equipment/GPU’s/wellhead/tanks/metering equipment/
Capacity
Installed
Cost
compressors//flow lines/ buildings/furniture & fixtures)

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