Form 330 - Tax Credit Summary And Certificate Request For Oil And Gas Production Tax Credits Page 11

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Alaska

Oil and Gas Production Tax Credits

under AS 43.55.023

Schedule E - Information & Documentation Required for Certificate - Continued

Federal EIN

Date of Claim

Tax Period

Taxpayer Name

Check Box if

Not Applicable

Date(s)

File

Notes to Information Filed (attached

to Current

Provided

Name(s)

additional pages as needed)

Claim

15 AAC 55.320(b)(6) if the lease or property where the exploration, development, or production

activities with respect to which the relevant expenditures were incurred took place is subject to a unit

operating agreement, identification of the applicable unit operating agreement;

15 AAC 55.320(b)(7) a list of any partners or other entities that shared in costs of which the relevant

expenditures incurred by the applicant are the applicant’s share;

15 AAC 55.320(b)(8) if the relevant expenditures are subject to joint venture audit by a participant in

a joint venture, identification of and contact information for the joint interest auditor; and

15 AAC 55.320(b)(9) in the case of a qualified capital expenditure incurred in connection with geological

or geophysical exploration or in connection with a well,... (B) documentation that the applicant has

submitted to the Department of Natural Resources all data referred to in AS 43.55.023(a)(2)(B).

Other Information and Documentation Provided (Describe) and list of applicable power of attorneys or waivers:

* If any of the information or documentation required above was provided in conjunction with another claim and has not changed for this claim, list the date(s) that it was provided, the file

name, and the method that the documentation or information was provided (e.g., via OTIS, email, mail, etc) in the columns above. Additional copies of the same documentation or information

is not required.

This form is available online at

Submit completed applications via the Tax Division’s Online Tax

Information System (OTIS) at