Oil & Gas Economic Profile Form - 1996
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1NEW YORK STATE OFFICE OF REAL PROPERTY SERVICES
Oil & Gas Economic Profile Form
For The year Ending December 31, 20___
DMN ID# ____________
Page ____ of ____
I. General Information
Company Name:
Formation:
Address:
Average Well Age:
Average Well Depth:
County:
Representative:
City or Town:
Phone Number:
Village:
II - Well Operating Conditions
Well type:
Production Type:
Royalty:
%
$
Gas
Stripper Wells
Land Owner Royalties
Oil
Other Wells
Overriding Royalty Interests
Gas & Oil
Enhanced Recovery Wells
Total Royalties
III - Gas Well Productions and Gas Gross Income
Quantity of Wells
Production (MCF)
Sale Price (per MCF)
Operator's Gross Income
IV - Oil Well Productions and Oil Gross Income
Quantity of Wells
Production (BBL)
Sale Price (per BBL)
Operator's Gross Income
V - Operating Expenses & Capital Expenditures
Total Operating Expenses
Per BBL or MCF
Per Well
Per Total
Capitalized Cost - New Wells
Per BBL or MCF
Per Well
Per Total
Capitalized Cost - Existing Wells
Per BBL or MCF
Per Well
Per Total
Reserve for Abandonment &
Well Plugging Cost
Per BBL or MCF
Per Well
Per Total
Book Depreciation
Per BBL or MCF
Per Well
Per Total
Certification:
I ____________________ , ______________ of _____________________________________ certify that the above
(Name)
(Title)
(Company)
stated Economic Profile data for the calendar year 20____ , is true to the best of my knowledge and belief.
_____ Check here if this is an Amended Form.
(Signature)
RP - 7019 11/96
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