FORM 1006A – FINANCIAL STATEMENT

FORM 1006A – FINANCIAL STATEMENT This presentation will assist you in the completion of the Form 1006A. The financial statement.

Date of Last Revision: 2009

Rule Requirement: OAC 165:10-1-11

Explanation of Form: Prior to drilling and/or operating a well, the operator shall furnish the Conservation Division a verifiable financial statement (minimum net worth $50,000.00 within the State of Oklahoma) or other present alternate surety, Form 1006 or 1006C. Operator must file an original copy on Form 1006A, which must be updated annually from the last filing date. [Reference 165:10-1-10 and 165:10-1-11] Question concerning this Form: Contact the Surety Department (405) 521-2246

FORM 1006A – FINANCIAL STATEMENT

NAME AND ADDRESS OF THE OPERATOR

FORM 1006A – FINANCIAL STATEMENT

ADDITIONAL ADDRESS INFORMATION

FORM 1006A – FINANCIAL STATEMENT

INDICATE TYPE OF ENTITY THAT THE OPERATOR IS

FORM 1006A – FINANCIAL STATEMENT

ALL OPERATORS PLEASE READ: All operators need to make sure they meet the minimum requirements of using this form

FORM 1006A – FINANCIAL STATEMENT

1. CASH ON HAND AND IN BANKS: All operators that report this information need to be sure and provide a name of their banker, the name of the bank and a phone number so, the information can be verified

FORM 1006A – FINANCIAL STATEMENT

2. U.S. Government Securities: All operators that report this information needs to provide detailed information of type of securities and value

FORM 1006A – FINANCIAL STATEMENT

3. Stocks: All operators that report stocks need to attach a list of type of stocks, the name of the stock broker, the name of the brokerage, and a phone number for verification purposes

FORM 1006A – FINANCIAL STATEMENT

5. CURRENT ACCOUNTS RECEIVIABLE

FORM 1006A – FINANCIAL STATEMENT

6. LOANS MADE TO OTHERS: All operators need to attach a list of each type of loan, the value of the loan and to whom the loan is due

FORM 1006A – FINANCIAL STATEMENT

7. OTHER: All operators should provide any additional liquid assets at this point. Make an attachment with details concerning the values listed

FORM 1006A – FINANCIAL STATEMENT

8. TOTAL OF ALL LIQUID ASSETS: Add items 1 thru 7

FORM 1006A – FINANCIAL STATEMENT

9. REAL ESTATE: All operators should attach a list of all properties, with legal locations and values as reported by the county assessor’s office

FORM 1006A – FINANCIAL STATEMENT

10. MINERAL WORTH: All operators that report this item needs to include a copy of an engineering report that was produced within the last 5 years

FORM 1006A – FINANCIAL STATEMENT

11. MACHINERY AND EQUIPMENT: All operators reporting this item needs to provide a summary of inventory along with an independent evaluation of the equipment along with the value and depreciation schedule

FORM 1006A – FINANCIAL STATEMENT

12. ALL OTHER ASSETS: All other types of assets should combined and listed here along with an attachment explaining each and how the value was arrived at

FORM 1006A – FINANCIAL STATEMENT

13. TOTAL OF ALL OTHER ASSETS: Add items 9 thru 13

FORM 1006A – FINANCIAL STATEMENT

14. TOTAL OF ALL ASSETS: Add item 8 and 13

FORM 1006A – FINANCIAL STATEMENT

15. NOTES PAYABLE TO BANKS: All operators reporting having notes payable to banks need to include the name of banker, the name of the bank and a phone number for verification purposes

FORM 1006A – FINANCIAL STATEMENT

16. NOTES PAYABLE TO OTHERS: All operators listing notes owed to others need to list the name to whom is owed and the value of the note

FORM 1006A – FINANCIAL STATEMENT

17. ACCOUNTS PAYABLE

FORM 1006A – FINANCIAL STATEMENT

18. OTHER SHORT OR INTERMEDIATE TERM LIABILITIES: All operators that list information here needs to include type of liability and value

FORM 1006A – FINANCIAL STATEMENT

19. TOTAL OF ALL SHORT TERM AND INTERMEDIATE LIABILITIES: Add items 15 thru 18

FORM 1006A – FINANCIAL STATEMENT

20. REAL ESTATE MORTGAGES: All operators reported this liability needs to include the name of the mortgage holder, a contact person and a phone number for verification purpose along with each value

FORM 1006A – FINANCIAL STATEMENT

21. OTHER LONG TERM LIABILITIES: All operators listing other long term liabilities should list the name of the holder of the note and a name of phone number for verification purposes

FORM 1006A – FINANCIAL STATEMENT

22. TOTAL OF LONG TERM LIABILITIES: Add items 20 and 21

FORM 1006A – FINANCIAL STATEMENT

23. TOTAL LIABILITIES: Add item 19 and 20

FORM 1006A – FINANCIAL STATEMENT

24. NET WORTH: Subtract item 23 from item 14, this number must exceed $50,000 or the operator cannot use this type of surety

FORM 1006A – FINANCIAL STATEMENT

LIABILITY INSURANCE: All operators need to answer whether they carry liability insurance and if so, who is the carrier, along with address and phone number

FORM 1006A – FINANCIAL STATEMENT

ALL OPERATORS SHOULD TAKE NOTE OF THIS INFORMATION BEFORE FILING THIS FORM

FORM 1006A – FINANCIAL STATEMENT

SIGNATURE OF THE PERSON COMPLETING THIS FORM, ALONG THE DATE COMPLETED, THE OTC/OCC OPERATOR NUMBER, NAME OF THE COMPANY, AND TITLE OF THE PERSON COMPLETING THIS FORM

FORM 1006A – FINANCIAL STATEMENT

NOTARY INFORMATION: This form cannot be processed unless it is notarized