INSTRUCTIONS FOR 4121: ANNUAL GROSS PRODUCTS BREAKDOWN BY TAX DISTRICT FOR OIL

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1 INSTRUCTIONS FOR : BREAKDOWN BY TAX DISTRICT FOR OIL INSTRUCTIONS FOR 4221: BREAKDOWN BY TAX DISTRICT FOR GAS COMPLETE (oil) or 4221 (gas) FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. Multiple tax districts can be two or more districts in the same county or two or more districts in two or more counties. PRODUCTION YEAR: calendar year in which production occurred. SECTION: Operator ID - 's Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division of the Wyoming. - 's name. NOT agent. SECTION: Reporting Group Number - the Reporting Group number assigned by the Mineral Tax Division. - Name of the producing asset. TAX DISTRICT BREAKDOWN OF TAXABLE VALUE Tax District - Enter county prefix and tax district. The county prefix and tax district of each well will be supplied to the operator by the Mineral Tax Division. EXAMPLE: Campbell County District 0100 would be Volume Produced - Operators enter volume produced and attributable to this tax district (well head volume). TIK interest owners skip this column. Volume Sold - Operators enter sales volume attributable to this tax district. TIK Interest owners enter volume taken in-kind attributable to this tax district.

2 Instructions for and 5221 Page 2 Taxable Value - Enter the dollar amount of 4101 Section D Line 9, attributable to the tax district listed. Totals - The total of the Volume Produced Column, (operators only), must equal 4101 Section D Line 4 (Oil), or 4201 Section C Line 1 (gas); the total of the Volume Sold Column must equal 4101 Section D Line 6 (oil), or 4201 Section D Line 6 plus Line 7 (gas); the total of the taxable value column must equal 4101 or 4201 Section D Line 9. COUNTY PREFIXES Albany 01 Natrona 25 Big Horn 03 Niobrara 27 Campbell 05 Park 29 Carbon 07 Platte 31 Converse 09 Sheridan 33 Crook 11 Sublette 35 Fremont 13 Sweetwater 37 Goshen 15 Teton 39 Hot Springs 17 Uinta 19 Johnson 19 Washakie 43 Laramie 21 Weston 45 Lincoln 23 rev. 12/5/2000

3 Gross Products Tax Reporting Instructions Production Year: Calendar year in which production occurred. s Operator ID as assigned by the Wyoming Oil and Gas Conservation Commission (WOGCC), or as assigned by the Mineral Tax Division. s name. Do not enter an agent s name here. The Reporting Group Number assigned by the Mineral Tax Division Enter the County Prefix and Tax District. The County Prefix and Tax District of each well will be supplied to the Operator by the Mineral Tax Division. Example: Campbell County District 100 would be entered as Operators enter the volume produced and attributable to this Tax District. Take In-Kind Interest Owners skip this column. Operators enter sales volume attributable to this Tax District. Take In-Kind Interest Owners enter volume taken attributable to this Tax District. Enter the dollar amount of Form 4101 Section D Line 9 attributable to this Tax District. Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must equal 4101, Section D, Line 9. COMPLETE FORM FOR EACH PROPERTY WHERE YOU HAVE REGISTERED A REPORTING GROUP THAT CONTAINS WELLS IN MULTIPLE TAX DISTRICTS. MULTIPLE TAX DISTRICTS CAN BE TWO Authorized OR MORE Signature DISTRICTS IN THE Title SAME COUNTY OR Date TWO OR MORE DISTRICTS IN TWO OR MORE COUNTIES. Form page 1

4 Gross Products Tax Reporting Instructions Production Year: County Prefixes Albany 01 Natrona 25 Big Horn 03 Niobrara 27 Campbell 05 Park 29 Carbon 07 Platte 31 Converse 09 Sheridan 33 Crook 11 Sublette 35 Fremont 13 Sweetwater 37 Goshen 15 Teton 39 Hot Springs 17 Uinta 41 Johnson 19 Washakie 43 Laramie 21 Weston 45 Lincoln 23 Operators Only: the total must equal Form 4101 Section D Line 4. The total must equal Form 4101 Section D Line 6. The total must equal Form 4101 Section D Line 9. Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must equal 4101, Section D, Line 9. Authorized Signature Title Date Form page 2

5 Production Year: Note: Total Volume Produced must equal 4101, Section D, Line 4; Total Volume Sold must equal 4101, Section D, Line 6; Total Taxable Value must equal 4101, Section D, Line 9. Authorized Signature Title Date