BOE-566-D

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe566d.pdf

This page watermarked sample only. Contact Assessor for actual form.

BOE-566-D (P1) REV. 11 (07-25)

OIL AND DISSOLVED GAS PRODUCTION REPORT FOR 20___ Declaration of costs and other related property information as of 12:01 A.M., January 1, 20___. File a separate report for each property.

1. NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address) OFFICIAL REQUIREMENT
A report submitted on this form is required of you by section 441(d) of
the Revenue and Taxation Code. The statement must be completed
according to the instructions and filed with the Assessor on or before
April 1, 20___. Failure to timely file the statement will compel the
Assessor’s Office to estimate the value of your property from other
information in its possession and add a penalty of 10 percent as
required by Revenue and Taxation Code section 463.

TELEPHONE NUMBER: ( )2. DESCRIPTION OF THE PROPERTY (A separate report must be filed for each property) Form

FIELD NAME LEASE NAME AND POOL

RECOVERY PRIMARY OTHER. DESCRIBE:3. PARCEL NUMBER TAX RATE AREAONLY

4. ZONE OR WELL NUMBER Actual

   PRODUCTION DATA INJECTION DATA
   NUMBER PRODUCING NUMBER INJECTION CALENDAR YEAR 20___ WATER OIL WATERforGAS STEAM (EXCLUDE WELLS DAYS WELLS DAYS DISPOSAL)

5. JANUARY FEBRUARY MARCH APRIL MAY JUNE SAMPLE JULY AUGUST SEPTEMBER Assessor OCTOBER NOVEMBER DECEMBER

6. JUL-DEC TOTAL

7. YEAR’S TOTAL

(use separate sheets as needed for the following) Contact 8. DEPTH TO ZONE BOTTOM 16. G. & G.L. INCOME, ANNUAL 9. ROYALTY RATE P G 17. GAS USED ON LEASE, MCF/YR 10. OIL GRAVITY, API DEC. 18. GAS SALES, MCF/YR 11. PRICE OF GAS PER MCF, DEC. 19. NGL SALES, GAL/YR 12. HEAT CONTENT - PRODUCED GAS - BTU/MCF 20. TRUCKING CHARGE PER BBL. 13. PRICE OF NGL SOLD PER GAL., DEC. 21. NAME OF CRUDE OIL BUYER 14. CRUDE OIL PRICE PER BBL., DEC. 22. SEVERANCE TAX PER BBL. 15. POSTED OIL FIELD

THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

This page watermarked sample only. Contact Assessor for actual form. BOE-566-D (P2) REV. 11 (07-25)

23. PROVED RESERVES AS OF YEAR END 100% OIL (BBL) 100% GAS (MMCF) ASSESSOR’S USE ONLY DEVELOPED UNDEVELOPED
24. BASIC WELL EQUIPMENT NUMBER OF WELLS TYPE ACTIVE IDLE DEPTH

PRODUCING FLOWING PRODUCING ARTIFICIAL LIFT IDLE WITH EQUIPMENT: GOOD IDLE WITH EQUIPMENT: FAIR IDLE WITH EQUIPMENT: POOR IDLE WITH NO EQUIPMENT IDLE RODS AND TUBING OBSERVATION INJECTION STEAM (NON-CYCLIC) INJECTION WATER Form INJECTION AIR/GAS WATER DISPOSAL WATER SUPPLY TOTAL ONLY 25. OTHER PRODUCTION EQUIPMENT - ADDITIONS AND REMOVALS ACQUISITION ORIGINAL COST ITEM NUMBER SIZE DATE INSTALLEDActual TANKS, WASH TANKS, LARGE STORAGE INJECTION EQUIPMENT for DISPOSAL EQUIPMENT SHIPPING PUMPS STEAM GENERATORS SCRUBBERS COMPRESSORS LACT SAMPLE

TOTAL

26. REMARKS Assessor

    DECLARATION BY ASSESSEE

    OWNERSHIP TYPE (R) Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties. Proprietorship I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, and that the foregoing and all information herein, including any accompanying statements or materials, is Partnership true, correct, and complete to the best of the taxpayer's knowledge and belief, and includes all property required

Corporation Contactto be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee Other in this statement at 12:01 a.m. on January 1, 20___. SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* DATE t NAME OF ASSESSEE OR AUTHORIZED AGENT * (typed or printed) TITLE

NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NUMBER

PREPARER’S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE ( ) EMAIL ADDRESS

• Agent: See page 4 for Declaration THIS REPORT IS SUBJECT TO AUDIT by Assessee instructions.

This page watermarked sample only. Contact Assessor for actual form.

BOE-566-D (P3) REV. 11 (07-25)

INSTRUCTIONS FOR COMPLETING OIL AND DISSOLVED GAS PRODUCTION REPORT

This report is not a public document. The information contained here will be held confidential by t he A ssessor ( section 451, Revenue and Taxation Code); it can be disclosed only to the district attorney, grand jury and other agencies specified in section 408 of the Revenue and Taxation Code. Attached schedules are considered to be part of the report. The Assessor’s failure to keep such records confidential could s ubject h im o r h er t o c ivil d amages ( Government C ode s ection 1 504), a nd i f s uch f ailure is determined to be willful, the Assessor may be subjected to other sanctions as provided by law (Government Code sections 3060 - 3074). Agents of the county hired as consultants are subject to the same provisions, sanctions and penalties upon failure to keep records confidential.

All personal property owned by the respondent and any property belonging to others on the lease as of January 1 must be reported to the Assessor on BOE-566-J, Oil, Gas and Geothermal Personal Property Statement.

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

LINE 1. NAME, MAILING ADDRESS AND PHONE NUMBER Form a. NAME OF OPERATOR (PERSON OR CORPORATION) If the name is preprinted, check the spelling and correct any error. 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 shouldONLYbe complete so they will not be confused with fictitious or DBA (Doing Business As) names.

b. DBA OR FICTITIOUS NAME Actual
Enter the DBA name under which you are operating in this county below the name of the sole owner, partnership, or
corporation. c. MAILING ADDRESS for
Enter the mailing address of the legal entity shown in line 1b 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.

d. PHONE NUMBER
Enter the phone number where we may contact you or your authorized representative for information regarding the subject
property. SAMPLE

LINE 2. DESCRIPTION OF THE PROPERTY Report each lease or parcel on a separate report form. Fill in oil field name, lease name and pool, and lease number. Conform to Division of Oil and Gas classification in regard to name of field, lease, and pool. Check whether recovery is primary Assessor or other type. If other, describe method, for example, waterflood, steam injection (cyclic or flood), fire flood, etc.

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

LINE 4. Submit a separate form for each Department of Energy (DOE) “Formation,” for example, Division of Oil and Gas recognized pool, and label according to the Division of Oil and Gas nomenclature.

LINE 5. Report oil (BBLS), water (BBLS) and gas (MCF) production and steam (BBLS) or water (BBLS) injection by months on a Contactcalendar year basis and the number of producing or injection wells and days. New wells and/or abandonments should be reported separately.

LINE 9. List the total royalty percent. For leasehold properties check appropriate Box P or G whether the lessor is a private party or a governmental agency and state the government royalty separately.

LINE 14. Report crude oil price per barrel at the end of December before any transportation charges.

LINE 15. Please list the posted oil field used as a reference for crude oil sales.

LINE 16. Report calendar year’s gas and gas liquids income to the property for working and royalty interests combined (excluding plant’s share of gas and gas liquids).

This page watermarked sample only. Contact Assessor for actual form.

BOE-566-D (P4) REV. 11 (07-25)

LINE 17. Report gas (MCF) used as lease fuel.

LINE 18. Report volume of gas (MCF) credited to lease after plant processing. This volume should be the same as that upon which royalty payments are based.

LINE 19. Report volume of (NGL) credited to lease after plant processing. This volume should be the same as that upon which royalty payments are based.

LINE 20. Indicate trucking charges per barrel if oil must be hauled.

LINE 23. Indicate your proved developed and undeveloped oil and gas reserves (as defined in Rule section 468 of the California Code of Regulations), as of the year end.

LINE 24. Report the number of wells by type, indicating the status and average depth. Idle with equipment (good, fair, poor), idle no equipment, and idle rods and tubing pertain to producing wells only. A well is considered active if used at least one day during December. Active producers and injectors should equal the number of wells reported for December in the production and injection data. An injector should be reported as a producer if the well was in production at any time during December. FormLINE 25. Report additions to or removals of improvements of your “Other Production Equipment.” Label removals. The Assessor may, on written notice, request annual reporting of previously existing equipment.

LINE 26. Any other information bearing on the value of the property may be recorded under “Remarks.” ONLY DECLARATION BY ASSESSEE The law requires that this production report, regardless of where it is executed, shall be declared to be true under penalty of perjury underthe laws of the State of California. The declaration must be signed by the assessee,Actuala 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 forCompany (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 a production report and who is required to have written authorization to provide proof of authorization. A production report that is not signed and executed in accordance with the foregoing instructions is not validly filed. The penalty imposed SAMPLE by section 463 of the Revenue and Taxation Code for failure to file is applicable to unsigned production reports. Assessor Contact