COLORADO BOARD OF LAND COMMISSIONERS 1313 Sherman Street, Suite 621 Denver, CO 80203 (303) 866-3772 www.trustlands.state.co.us OIL & CONDENSATE ROYALTY REPORT
Original
Adjustment
1. Royalty Accounting Unit No. (RAU) _______________________
Production Month & Year _________________________
2. Lease Name __________________________________________________________Number of Wells __________________ 3. SUBSECTION OF SECTION _______________ SECTION _______ TOWNSHIP _________ RANGE _________
4. Operator ___________________________________ 5. Operator’s Lease No. _________________________ 6. Crude Oil Sale 7. 8. _______ Condensate Sale
Purchaser ______________________________ Multiple _______ Purchaser’s Lease No. ____________________
_______ Mixed Sale _______ Average Unit Price: $ ________________________ Gross Sales: $ ________________________
Average API Gravity: Barrels Sold:
_______________________ _______________________
9. Percent Participation 10. 11. 12.
__________________
State Royalty Interest ROYALTY DUE:
_____12.5%________ $ ________________________ $ ________________________ $ ________________________
For adjusted reports, previous amount paid: AMOUNT DUE: __________________
13. Total of Check Submitted:
Check No(s). __________________________________
14. If this is an adjustment, please explain. _____________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Contact Name _______________________________________________________ Telephone No. _______________________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------I certify that this is a true and correct statement of production sold, value received, and royalty due the State of Colorado for the period indicated. _______________________________________________________________________ Authorized Signature & Title Check if new Address __________ Reporting Company Name __________________________________________________ SLB Payor Number Address
__________
________________________________________________________________________________ ________________________________________________________________________________
Subscribed and sworn to before me by ____________________________
on this ________
day of ________________, 20____.
Notary Public __________________________________________________ My Commission Expires _______________________________
Date Stamp
Land Board Use Only
Verified Posted Notes 05/02
______________ ______________
Receipt No. Date
________________ ________________
__________________________________________________
_________________________________________________________
COLORADO BOARD OF LAND COMMISSIONERS 1313 Sherman Street, Suite 621 Denver, CO 80203 Phone: (303) 866-3772 Fax: (303) 866-3152
www.trustlands.state.co.us
INSTRUCTIONS FOR PREPARING OIL AND CONDENSATE ROYALTY REPORTS These instructions pertain to the Colorado Board of Land Commissioners monthly Oil and Condensate Royalty Report. The instructions follow the same order as the report. Numbered items in the instructions correspond to line numbers in the report. Original Adjustment
This information indicates to the Land Board that the report is either the first report submitted for a Royalty Accounting Unit for a royalty month, or a report that modifies information submitted in a previous report. Check “Original” if this is the first report submitted. Check “Adjustment” if this is an adjusted report. If the report is an adjusted report, fill in all of the data necessary to calculate the State royalty for the month being adjusted as if you had never reported it before. This will include total volumes sold and unit prices. 1. Royalty Accounting Unit - Fill in the Royalty Accounting Unit Number that has been Assigned by the Land Board. A separate Royalty Accounting Unit will be established for each State royalty interest in a producing (division order) lease. If all wells on a State lease have identical royalty, overriding royalty, and working interests, and are operated by the same operator, a single Royalty Accounting Unit will normally be assigned to account for all royalties from that lease. If all wells on a state lease do not have the same operator and identical divisions of interest, a separate Royalty Accounting Unit will be established for each group of wells that are the same. If more than one State lease shares in the production from a unitized or communitized area, a separate Royalty Accounting Unit will be established for the royalty interest of each lease. Fill in the Production Month and Year. 2. Lease Name - Enter the operator’s name of the lease or property. Number of wells - Enter the number of producing wells that existed in the Royalty Accounting Unit during the month being reported. Do not include shut-in wells. 3. Subsection of Section, Section, Township, Range - Enter the subsection of Section, i.e. NE/4, S/2, All; Section Number; Township; and Range of the land included in the Royalty Accounting Unit. If the property covers more than one section, list the section numbers, but do not list the subsection data. 4. Fill in the names of the Operator of the lease and the oil Purchaser. If there is more than one purchaser, fill in the name of the major purchaser and place a check on the line by Multiple.
5. Enter the Operator’s Lease Number and/or the Purchaser’s Lease Number, whichever is appropriate. 6. Check whether the sales during the report month were for Crude Oil, Condensate, or Mixed (crude oil and condensate). 7. Enter the weighted Average API Gravity, and the weighted Average Unit Price for all oil and condensate sold during the month. 8. Enter the total Number of Barrels of oil and condensate sold during the report month and the dollar value of Gross Sales. 9. Percent Participation - If the Royalty Report is for a Unit or Communitized area, enter the Percent Participation of the State lease for which the report is being prepared. Enter this number as a percentage, i.e. 48.25%. If the area is not unitized or communitized, enter 100%. State Royalty Interest - The Royalty Interest of the State of Colorado in the State Lease for which the report is being prepared has been entered demonstrating 12.5% (0.125 or one-eighth). This is the royalty interest that is stated in the Board of Land Commissioners’ Oil and Gas Lease. There are very few leases in which this royalty interest is incorrect. 10. Enter the Royalty Due. The royalty due is equal to: Gross Sales X Percent Participation X State Royalty Interest 11. If the report is an adjusted report, enter the previous amount paid for the royalty month being adjusted. When more than one adjusted report has been submitted, report the last royalty due amount that was reported. 12. The AMOUNT DUE is equal to line 10 minus line 11. 13. Enter the total remittance accompanying the report. This amount will equal the sum of all checks remitted with the report and may include funds for other reports and interest and penalty bills. List the Numbers of all Checks remitted with the royalty report(s). 14. If this is an adjusted report, explain in detail the reason for the adjustments. The remainder of the report is self-explanatory and must be filled out completely. The SLB Payor Number will be provided by the State Land Board.
Instructions for Adjusted Reports for Oil & Gas production
Separate reports are due on each Royalty Accounting Unit for each month for which there is an adjustment. Place an “X” in the box to the right of Adjustment to distinguish the report from an original report. On Line 1, indicate the month and year for which the adjustment is being made. (Example: a report is submitted in June to adjust a January report -- the date shown on the report will be January.) All lines not mentioned below will be filled out as though it were an original report. FOR GAS: Lines 9 - 18 should be reported as though you had never submitted a report. In other words, what was actually sold to the best of your knowledge on this date, regardless of any prior reports or payments made to the Land Board. Line 20 should show the royalty due based on the information given on lines 9 - 18. Line 21 should show the amount previously paid for this sales month for this Royalty Accounting Unit. Line 22 will be the net difference between lines 20 and 21. It is the amount of additional royalty due the Land Board or the amount of the credit you may take against current royalty due. Line 24 is for your explanation of this adjustment. FOR OIL: Lines 6 - 8 should be reported as though you had never submitted a report. In other words, what was actually sold to the best of your knowledge on this date, regardless of any prior reports or payments made to the Land Board. Line 10 should show the royalty due based on the information given on lines 6 - 8. Line 11 should show the amount previously paid for this sales month for this Royalty Accounting Unit. Line 12 will be the net difference between lines 10 and 11. It is the amount of additional royalty due the Land Board or the amount of the credit you may take against current royalty due. Line 14 is for your explanation of this adjustment.