Form Atd39 - Drilling Rig Equipment Personal Property-Owned Declaration Schedule Page 2

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State of Wyoming,
Page
Form ATD39
DRILLING RIG EQUIPMENT
PERSONAL PROPERTY—OWNED
DECLARATION SCHEDULE
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 drilling rig equipment you own. Please sign the reporting
NAICS CODE: _____________________
rendition on the bottom of page 4 and return the completed form by March 1.
Contact Person
Telephone
Rig Name
Rig Number/API #
Rig Age
Stacked Rigs % Complete
Capable of Operation
[
] Yes
[
] No
Drilling for:
[
] Gas
[
] Oil
[
] CBM
Drawworks
Make
Model
Depth Rating
Feet
[
] Electric
[
] Mechanical
Engines
Make
HP Rating
Make
HP Rating
Top Drive Tons Capacity: _____________________
Make
HP Rating
Drill Pipe
Joints
Feet
Size
Lbs. Per Foot
Grade
New/Used
Installed Cost
Tool Pusher Living Quarters or Location
Size: Length x Width
Year Built
Capacity—# of People

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