Organization Report - Form 2

Organization Report - Form 2 Department of Mineral Resources Oil and Gas Division S.F.N 5748 (08 to 2026)

Please Read Instructions Before Completing Form. Please Submit the Original.

Field: Full Name of Company, Organization or Individual

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Form of the Organization (i.e. Corporation, Joint Stock Association, Partnership, etcetera)

Field: State the Purpose of the Organization (i.e. Producer, Pipeline, Refiner, etcetera)

Field: State Where Incorporated

Field: Initial Filing Date with N.D.S.O.S/S.O.S Control I.D Number

Field: Name of North Dakota Registered Agent

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Organization Officers and Directors

Field: Officer Title

Field: Name

Field: Post Office Address

Field: Officer Title

Field: Name

Field: Post Office Address

Field: Officer Title

Field: Name

Field: Post Office Address

Field: Officer Title

Field: Name

Field: Post Office Address

Field: Officer Title

Field: Name

Field: Post Office Address

Northstar Administrator

Field: First and Last Name

Field: Telephone Number

Field: E-Mail Address

Is this a reorganization?

Checkbox option: No

Checkbox option: Yes - What was the previous organization?

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

Field: State of

Field: County of

Signed and sworn to (or affirmed) before me this

Field: Date

Field: Name(s) of Individual(s) Making Statement

Field: Affix Notary Stamp

Field: Signature of Notary Public or Other Authorized Officer

Field: Commission Expiration Date

Organization Report - Form 2 S.F.N 5748

1. Please refer to Section 43-02-03-11 of the North Dakota Administrative Code regarding organization reports.

2. The Form 2 needs to be completed in its entirety. The name of company, organization, or individual shall be the operator name.

3. The name of company, organization, or individual shall be the same as appears on bonding form(s).

4. The company must be registered with the North Dakota Secretary of State in order to do business in North Dakota.

5. The Organization Officers and Directors section must be completed.

a. Officer title needs to be filled in (i.e. President, Vice President, C.E.O, Owner, Director, etcetera).

b. Please list if the L.L.C is a single-owner entity.

c. If more space is needed to supply a complete organization officer's list, please attach a separate document containing the full list.

6. This report must accompany the bond form when a new bond is filed or if there is a principal name change on a bond.

7. This report shall be approved before drilling permits will be issued to your organization. After the initial filing, additional reports shall be filed when and if there is a change in any of the information contained in the original report.

8. 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. 7. At least one Northstar administrator is required. First name, last name, phone number and email address should be completed on the form. This user will manage all other users for the organization.