Form EIA-23L Annual Report of Domestic Oil and Gas Reserves (County L

U.S. DEPARTMENT OF ENERGY ENERGY INFORMATION ADMINISTRATION Washington DC 20585

OMB No. 1905-0057 Expiration Date: xx/xx/xxxx Version No.: xxxx.xx Burden: 45 hours

FORM EIA-23L ANNUAL REPORT OF DOMESTIC OIL AND GAS RESERVES

REPORT YEAR 201X COVER PAGE

This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). For the provisions concerning the confidentiality of information and sanction statements, see Section VII and VIII of the instructions.

Resubmission?

PART I. IDENTIFICATION

Complete and return by May 1, 201X via: https://signon.eia.doe.gov/upload/noticeoog.jsp Email: [email protected] Fax: 202-586-1076 Mail: Oil and Gas Surveys U.S. Department of Energy, EIA Ben Franklin Station P O Box 279 Washington DC 20044-0279 Questions? Call 1-800-879-1470

EIA Operator ID Code Operator Name Street or PO Box City, State, Zip Code

Enter EIA Operator ID number, if not shown.

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¨ If any Contact Person Information has changed since the last report, please check this box.

1. Primary Contact Information (person most knowledgeable about the reported data) Contact Person ___________________________________________ Phone Number ____________________________ Ext ________ __ Fax Number ___________________________________________ E-mail Address ___________________________________________ Enter any changes in Item 5.

2. Secondary Contact Information (optional) Contact Person ____________________________________________ Phone Number ______________________________ Ext __________ Fax Number ___________________________________________ E-mail Address ___________________________________________

3. Was your company an oil and gas field operator at any time during report year 201X? (See Section B Who Must Submit, page 2 in instructions.)

4. Company Status, Name, and/or Address Change or Correction (Check appropriate box and update any information in box 5.)

¨ Company name, contact person, and mailing address are correct

¨ Yes Complete all of the form

¨ Company was sold to or merged with company entered below

¨ No Complete only items 4 -13 below and return this page

¨ Company out of business and operations transferred to company below

5. Enter Company Name, Address, and/or Contact Information

Company Name (please print)

Street or PO Box

City, State, Zip Code

Contact Person

Phone Number Ext

Fax

Email Address

6. During report year 201X did you acquire any oil and gas operating companies? ¨ Yes Report the name of the acquired companies, the state(s) the properties are located in, and the approximate date operations transferred ¨ No Skip to Item 7 Example: Company ABC in CO, NM, and UT acquired May 2016

Title 18 USC 1001 makes it a criminal offense for any person knowingly and willingly to make to any Agency or Department of the United States any false, fictitious, or fraudulent statements as to any matter within its jurisdiction.

U.S. DEPARTMENT OF ENERGY ENERGY INFORMATION ADMINISTRATION Washington DC 20585

OMB No. 1905-0057 Expiration Date: xx/xx/xxxx Burden: 45 hours

FORM EIA-23L ANNUAL REPORT OF DOMESTIC OIL AND GAS RESERVES

REPORT YEAR 201X COVER PAGE (continued)

This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). For the provisions concerning the confidentiality of information and sanction statements, see Section VII and VIII of the instructions.

PART I. IDENTIFICATION (continued)

EIA Operator ID Code

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Operator Name ______________________________________

7. During report year 201X are you completing this form for any subsidiaries/affiliated companies? ¨ Yes List the subsidiary/affiliated companies for which you are reporting and EIA Operator Code if applicable ¨ No Skip to Item 8 Example: Company XYZ EIA Operator Code 1234560000

PART II. PARENT COMPANY IDENTIFICATION

8. Is there a parent company which exercises control over your company ? ¨ Yes Answer 9 through 13 ¨ No Answer 10 through 13

9. Parent Company Name Address City State Zip

COMMENTS

PART III. APPROVAL

10. Reviewed and approved by (Please Print)

11. Title

12. Signature

13. Date

Title 18 USC 1001 makes it a criminal offense for any person knowingly and willingly to make to any Agency or Department of the United States any false, fictitious, or fraudulent statements as to any matter within its jurisdiction.

OFFICIAL USE ONLY

201X

FORM EIA-23L ANNUAL REPORT OF DOMESTIC OIL AND GAS RESERVES SCHEDULE A - OPERATED PROVED RESERVES, PRODUCTION, AND RELATED DATA BY COUNTY

OMB No. 1905-0057 Expiration Date: xx/xx/xxxx Burden: 45 hours

Report All Liquid Volumes in Thousands of Barrels [MBbls] at 60°F Report All Volumes of Natural Gas in Millions of Cubic Feet [MMCF] at 60°F and 14.73 psia

1.0 OPERATOR DETAILED DATA REPORT

1.1 EIA OPERATOR ID CODE

1.2 OPERATOR NAME

REPORT dATE

1.3 original

1.4 amended

1.5 page

12

31

xx

______ of _____

2.0 COUNTY data (operated basis)

1. state Code

2. Subdiv Code

3. County Code

4. COUNTY NAME

5. TYPE cODE

6. field, PLAY, OR PROSPECT name (OPTIONAL)

7. PROVED NONPRODUCING RESERVES – DECEMBER 31, 201X

8. FOOTNOTE

2.1

CRUDE OIL (a) (MBbls)

ASSOCIATED-DISSOLVED (b) GAS (MMCF)

nonassociated (c) GAS (MMCF)

LEASE CONDENSATE (d) (MBbls)

9. # of PRODUCING WELLS AS OF DECEMBER 31ST

10. # OF Wells completed or purchased IN 201x

11. # OF WELLS abandoned or sold in 201x

type of hydrocarbon

TOTAL PROVED reserves december 31, 201(x-1) (A)

revision increases (B)

revision DEcreases (C)

SALES (D)

ACQUISITIONS (E)

EXTENSIONS AND DISCOVERIES (F)

REPORT YEAR production (G)

TOTAL PROVED reserves december 31, 201X (H)

12. CRUDE OIL (MBbls)

13. ASSOCIATED-DISSOLVED GAS (MMCF)

14. NONASSOCIATED GAS (MMCF)

15. LEASE CONDENSATE (MBbls)

1. state Code

2. Subdiv Code

3. County Code

4. County NAME

5. TYPE cODE

6. field, PLAY, OR PROSPECT name (OPTIONAL)

7. PROVED NONPRODUCING RESERVES – DECEMBER 31, 201X

8. FOOTNOTE

2.2

CRUDE OIL (a) (MBbls)

ASSOCIATED-DISSOLVED (b) GAS (MMCF)

nonassociated (c) GAS (MMCF)

LEASE CONDENSATE (d) (MBbls)

9. # of PRODUCING WELLS AS OF DECEMBER 31ST

10. # OF Wells completed or purchased IN 201X

11. # OF WELLS abandoned or sold in 201X

type of hydrocarbon

TOTAL PROVED reserves december 31, 201(x-1) (A)

revision increases (B)

revision DEcreases (C)

SALES (D)

ACQUISITIONS (E)

EXTENSIONS AND discoveries (f)

REPORT YEAR production (G)

TOTAL PROVED reserves december 31, 201X (H)

12. CRUDE OIL (MBbls)

13. ASSOCIATED-DISSOLVED GAS (MMCF)

14. NONASSOCIATED GAS (MMCF)

15. LEASE CONDENSATE (MBbls)

1. state Code

2. Subdiv Code

3. County Code

4. COUNTY NAME

5. TYPE cODE

6. field, PLAY, OR PROSPECT name (OPTIONAL)

7. PROVED NONPRODUCING RESERVES – DECEMBER 31, 201X

8. FOOTNOTE

2.3

CRUDE OIL (a) (MBbls)

ASSOCIATED-DISSOLVED (b) GAS (MMCF)

nonassociated (c) GAS (MMCF)

LEASE CONDENSATE (d) (MBbls)

9. # of PRODUCING WELLS AS OF DECEMBER 31ST

10. # OF Wells completed or purchased IN 201X

11. # OF WELLS abandoned or sold in 201X

type of hydrocarbon

TOTAL PROVED reserves december 31, 201(X-1) (A)

revision INcreases (B)

revision DEcreases (C)

SALES (D)

ACQUISITIONS (E)

EXTENSIONS AND DISCOVERIES (F)

REPORT YEAR production (G)

TOTAL PROVED reserves december 31, 201X (H)

12. CRUDE OIL (MBbls)

13. ASSOCIATED-DISSOLVED GAS (MMCF)

14. NONASSOCIATED GAS (MMCF)

15. LEASE CONDENSATE (MBbls)

OFFICIAL USE ONLY

201X

FORM EIA-23L ANNUAL REPORT OF DOMESTIC OIL AND GAS RESERVES SCHEDULE B – FOOTNOTES

OMB No. 1905-0057 Expiration Date:xx/xx/xxxx Burden: 45 hours

1.1 EIA OPERATOR ID CODE

1.2 OPERATOR NAME

REPORT DATE

1.3 ORIGINAL

1.4 AMENDED

1.5 PAGE

____ of ____

STATE CODE (A)

SUBDIV CODE (B)

COUNTY CODE (C)

TYPE CODE (D)

HYDROCARBON TYPE (E)

COLUMN (F)

FOOTNOTES (G)