ALASKA DNR - OIL & GAS V 1.201112 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 000012345N12201200 AUTHORIZED DATE 12/22/2012 ADL # LEASE NUMBER LESSEE NAME XYZ Company ADDRESS1 Enter Data ADDRESS2 Enter Data CITY Enter Data Enter Data STATE ZIP Enter Data PREPARER Enter Data PREPARER PHONE NUMBER Enter Data PREPARER FAX NUMBER Data AUTHORIZED SIGNATURE (CODE) Data Data AUTHORIZED SIGNATURE (Printed Name) NUMBER Enter Data FAX NUMBER Enter Data
ALASKA DNR - OIL & GAS V 1.201112 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 000012345N12201200 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 Enter Data PREPARER Enter Data PREPARER PHONE NUMBER Enter Data PREPARER FAX NUMBER Data AUTHORIZED SIGNATURE (CODE) Data AUTHORIZED SIGNATURE (Printed Name) Data NUMBER Enter Data FAX NUMBER Enter Data
ReportingSectIIE_PT_201212.docx