Purchaser and Transporter of Dry Gas Report - Form 8a

Purchaser and Transporter of Dry Gas Report - Form 8A Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5754 (03 to 2000)

Field: Page

Field: of

Checkbox option: Amended

Please Read Instructions Before Filling Out Form.

Please Submit the Original.

Field: For Month/Year

Field: Name of Transporter

Field: Name of Purchaser

Field: Telephone Number

Field: Operator

Field: Address

Field: City

Field: State

Field: Zip Code

Gas Plant Name or Well Name

Gas Plant I.D Number or Well File Number

Field

M.C.F Received

Field: Comments

I hereby swear or affirm that the information provided is true, complete and correct as determined from all available records.

Field: Date

Field: Signature

Field: Printed Name

Field: Title

Above Signature Witnessed By

Field: Witness Signature

Field: Witness Printed Name

Field: Witness Title

Purchaser and Transporter of Dry Gas Report - Form 8A S.F.N 5754

1. Gas plant name refers to the gas processing plant where dry gas is received.

2. The operator, gas plant name or well name, the gas plant I.D number or well file number, and the field shall be used to identify the gas plant or well and shall coincide with the official records on file with the Commission.

3. The gas volumes shall be reported as M.C.F corrected to 14.73 psia and 60 degrees F.

4. The gas volumes shall be corrected to a pressure of 14.73 psia and 60 degrees F.

5. If this is an amended report, the amended volumes shall be clearly indicated.

6. The original of this report shall be filed with the Department of Mineral Resources, Oil and Gas Division, 600 East Boulevard, Dept. 474, Bismarck, N.D 58505 to 0614 by the fifth day of the second succeeding month.