ALASKA DNR - OIL & GAS V 1.201212 REPORT TYPE (PTLA Report) PT REPORT CODE (NPSL Report) AL FILING TYPE REG CUSTOMER ID NUMBER 000012345 PRODUCTION MONTH 10/01/2012 REVISION NO. 00 REPORT MONTH 12/01/2012 CONTROL NUMBER 000012345N12212000 AUTHORIZED DATE 12/22/2012 LEASE NUMBER ADL # LESSEE NAME XYZ Company ADDRESS1 Enter Data ADDRESS2 Enter Data CITY Enter Data STATE Enter Data ZIP Data PREPARER Enter Data PREPARER PHONE NUMBER Enter Data PREPARER FAX NUMBER Enter Data AUTHORIZED SIGNATURE (CODE) Enter Data Enter Data AUTHORIZED SIGNATURE (Printed Name) PHONE NUMBER Enter Data FAX NUMBER Data PPT ACCOUNT ALLOCATION LINE NO. QUANTITY VALUE RATE AMOUNT REPORT CODE CODE 1 PTR PR TCR PTR 2 PR TOI PTR 3 PR OVHR PTR 4 PR GOAE PTR 5 PR AVT PTR 6 PR NOP PTR 7 PR AANOH PTR 8 PR TRYE PTR 9 PT KPRK PTR 10 PT BNDCPT PTR 11 PT PTR 12 DV TOI PTR 13 DV OVHR PTR 14 DV GOAE PTR 15 DV RTO PTR 16 PT CEER PTR 17 PT
ALASKA DNR - OIL & GAS V 1.201212 REPORT TYPE (PTLA Report) PT REPORT CODE (NPSL Report) AL FILING TYPE REG CUSTOMER ID NUMBER 000012345 PRODUCTION MONTH 10/01/2012 REVISION NO. 00 REPORT MONTH 12/01/2012 CONTROL NUMBER 000012345N12212000 AUTHORIZED DATE 12/22/2012 LEASE NUMBER ADL # LESSEE NAME XYZ Company ADDRESS1 Enter Data ADDRESS2 Enter Data CITY Enter Data STATE Enter Data ZIP Data PREPARER Enter Data PREPARER PHONE NUMBER Enter Data PREPARER FAX NUMBER Enter Data AUTHORIZED SIGNATURE (CODE) Enter Data AUTHORIZED SIGNATURE (Printed Name) Enter Data PHONE NUMBER Enter Data FAX NUMBER Data LINE NO. PPT REPORT ACCOUNT CODE ALLOCATION CODE QUANTITY VALUE RATE AMOUNT 1 PTR PR TCR 2 PTR PR TOI 3 PTR PR OVHR 4 PTR PR GOAE 5 PTR PR AVT 6 PTR PR NOP 7 PTR PR AANOH 8 PTR PR TRYE 9 PTR PT KPRK 10 PTR PT BNDCPT 11 PTR PT 12 PTR DV TOI 13 PTR DV OVHR 14 PTR DV GOAE 15 PTR DV RTO 16 PTR PT CEER 17 PTR PT