5. Completed S1 Form: NPSL Filing Example ALASKA DNR - OIL & GAS V 1.20120723 REPORT TYPE S1 REPORT CODE P FILING TYPE REG CUSTOMER ID NUMBER 000106346 REVISION NO. 0 REPORT MONTH 12/01/2012 CONTROL NUMBER 000106346N12201200 12/17/2012 AUTHORIZED DATE PAYMENT METHOD WTN PAYMENT SETTLEMENT DATE 12/31/2012 AMOUNT ELECTRONICALLY TRANSFERRED $22,960,664.32 BANK NAME Large Bank BANK LOCATION Houston, Texas LESSEE NAME Any Company ADDRESS1 P.O. Box 100360 ADDRESS2 Anchorage CITY Alaska ZIP 99510 PREPARER Jane Doe PREPARER PHONE NUMBER 9072634883 PREPARER FAX NUMBER 9072634885 ABCDEFGHIJ AUTHORIZED SIGNATURE (CODE) AUTHORIZED SIGNATURE (Printed Name) Jane Doe PHONE NUMBER 9076652811 FAX NUMBER 9076652812 ACCOUNTING REPORT ALLOCATION LEASE/CID LINE NO. PAYMENT DATE PAYMENT UNIT CODE CODE CODE NUMBER 1 NPP PRIN 389981 $124,811.88 2 LEASE NPP INTR 389981 $0.00 3 LEASE NPP TPMT 389981 $124,811.88 4 NPP PRIN 389982 $1,168.28 5 LEASE NPP INTR 389982 $0.00 6 LEASE NPP TPMT 389982 $1,168.28 7 LEASE NPP PRIN 389983 $4,344,305.92 8 LEASE NPP INTR 389983 $0.00 9 LEASE NPP TPMT 389983 $4,344,305.92 10 LEASE NPP PRIN 389984 $20,146.26 $0.00 11 LEASE NPP INTR 389984
5. Completed S1 Form: NPSL Filing Example ALASKA DNR - OIL & GAS V 1.20120723 REPORT TYPE S1 REPORT CODE P FILING TYPE REG CUSTOMER ID NUMBER 000106346 REVISION NO. 0 REPORT MONTH 12/01/2012 CONTROL NUMBER 000106346N12201200 AUTHORIZED DATE 12/17/2012 PAYMENT METHOD WTN PAYMENT SETTLEMENT DATE 12/31/2012 AMOUNT ELECTRONICALLY TRANSFERRED $22,960,664.32 BANK NAME Large Bank BANK LOCATION Houston, Texas LESSEE NAME Any Company ADDRESS1 P.O. Box 100360 ADDRESS2 CITY Anchorage Alaska ZIP 99510 PREPARER Jane Doe PREPARER PHONE NUMBER 9072634883 PREPARER FAX NUMBER 9072634885 AUTHORIZED SIGNATURE (CODE) ABCDEFGHIJ AUTHORIZED SIGNATURE (Printed Name) Jane Doe PHONE NUMBER 9076652811 FAX NUMBER 9076652812 LINE NO. ACCOUNTING UNIT CODE REPORT CODE ALLOCATION CODE LEASE/CID NUMBER PAYMENT DATE PAYMENT 1 NPP PRIN 389981 $124,811.88 2 LEASE NPP INTR 389981 $0.00 3 LEASE NPP TPMT 389981 $124,811.88 4 NPP PRIN 389982 $1,168.28 5 LEASE NPP INTR 389982 $0.00 6 LEASE NPP TPMT 389982 $1,168.28 7 LEASE NPP PRIN 389983 $4,344,305.92 8 LEASE NPP INTR 389983 $0.00 9 LEASE NPP TPMT 389983 $4,344,305.92 10 LEASE NPP PRIN 389984 $20,146.26 11 LEASE NPP INTR 389984 $0.00