Line numbers listed in these instructions refer to identical line numbers printed on the form. At top of form, fill in the year of the lien date for which this expense report is made.

LINE 1. DATE, NAME, MAILING ADDRESS AND PHONE NUMBER

1. NAME OF OPERATOR (person or corporation)
   If the name is preprinted, check the spelling and correct any errors. In the case of an individual, enter the last name first, then the first name and middle initial. Partnerships must enter at least two names, showing the last name, first name, and middle initial for each partner. Corporation names should be complete so they will not be confused with fictitious or DBA (Doing Business As) names.
   
2. DBA OR FICTITIOUS NAME
   Enter the DBA name under which you are operating in this county below the name of the sole owner, partnership or corporation.
   
3. MAILING ADDRESS
   Enter the mailing address of the legal entity shown in line 1a. above. This may be either a street address or a post office box number. It may differ from the actual location of the property. Include the city, state, and zip code.
   
4. PHONE NUMBER
   Enter the phone number where we may contact you or your authorized representative for information regarding the subject property.
   

LINE 2. DESCRIPTION OF THE PROPERTY

Report each lease, parcel or "operating unit" on a separate report form. Operating unit refers to the accumulated total of wells producing in concert to supply a designated energy generation system. Fill in field, lease name, and unit number.

Conform to Division of Oil and Gas classification in regard to name of field, unit or lease.

LINE 3. PARCEL NUMBER
Fill in the parcel number and tax rate area number, if known.

LINE 4. WELL DATA - Indicate type

LINES 5 and 6. Producing wells reported are those wells which actually contribute to normal unit production on a profitable basis. Indicate number producing and average well depth for the zone.

LINE 7. Indicate number of shut in wells capable of production.

LINE 8. Indicate number of idle wells incapable of production (a) with equipment intact, (b) without equipment intact.

LINE 9. Indicate number of injection wells and average depth.

LINE 10. Indicate number of water supply wells and check one of the boxes to indicate whether they are fresh or salt water wells.

LINE 11. Indicate number of disposal wells and their average depth.

LINES 12 thru 29. FIELD OPERATING EXPENSE
Report direct field operating expenses only. Do not report capitalized items or royalty payments on these lines. Overhead expense applies to direct field overhead, district overhead, or any other direct overhead expenses relating to this lease or unit operation.

LINES 30 thru 35. CAPITAL EXPENDITURES
Wells, remedial well work, abandonments and surface investment are those incurred during the calendar year being reported. Do not include items such as roads under new well cost, but report these separately on line 33.

Do not include depreciation, depletion, amortization, interest, federal and state income taxes, property taxes, royalty payments, and general office overhead.

DECLARATION BY ASSESSEE

The law requires that this expense data statement, regardless of where it is executed, shall be declared to be true under penalty of perjury under the laws of the State of California. The declaration must be signed by the assessee, a duly appointed fiduciary, or a person authorized to sign on behalf of the assessee. In the case of a corporation the declaration must be signed by an officer or by an employee or agent who has been designated in writing by the board of directors, by name or by title, to sign the declaration on behalf of the corporation. In the case of a partnership, the declaration must be signed by a partner or an authorized employee or agent. In the case of a Limited Liability Company (LLC), the declaration must be signed by an LLC manager, or by a member where there is no manager, or by an employee or agent designated by the LLC manager or by the members to sign on behalf of the LLC.

When signed by an employee or agent, other than a member of the bar, a certified public accountant, a public accountant, an enrolled agent or a duly appointed fiduciary, the assessee's written authorization of the employee or agent to sign the declaration on behalf of the assessee must be filed with the Assessor. The Assessor may at any time require a person who signs an expense data statement and who is required to have written authorization to provide proof of authorization.

An expense data statement that is not signed and executed in accordance with the foregoing instructions is not validly fi led. The penalty imposed by section 463 of the Revenue and Taxation Code for failure to file is applicable to unsigned expense data statements.