BOE-502-G

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe502g.pdf

This page watermarked sample only. BOE-502-G (P1) REV. 07 (07-25) Contact Assessor for actual form. CHANGE IN OWNERSHIP STATEMENT OIL AND GAS PROPERTY

File this statement by:

BUYER/TRANSFEREE

MAILING ADDRESS RECORDING DATA Date Recorded: SELLER/TRANSFEROR Document Number: Assessor’s Identification Number: MAILING ADDRESS MB PG PCL FIELD LEASE Phone Numbers: ( ) Buyer: ( ) Form Seller: IMPORTANT NOTICE Sec: Twp: Rng: The law requires any transferee acquiring an interest in real property or manufactured home subject to local property taxation, and that is assessed by the county assessor, to file a Change in Ownership Statement with the County Recorder or Assessor. The Change in OwnershipStatement must be filed at the time of recording or, if the transfer is not recorded,ONLYwithin 90 days of the date of the change in ownership, except that where the change in ownership has occurred by reason of death the statement shall be filed within 150 days after the date of death or, if the estate is probated, shall be filed at the time the inventory and appraisal is filed. The failure to file a Change in Ownership Statement within 90 days from the date of a written request by the Assessor results in a penalty of either: (1) one hundred dollars ($100); or (2) 10 percent of the Actualtaxes applicable to the new base year value reflecting the change in ownership of the real property or manufactured home, whichever is greater, but not to exceed five thousand dollars ($5,000) if the property is eligible for the homeowners’ exemption or twenty thousand dollars ($20,000) if the property is not eligible for the homeowners’ exemption if that failure to file was not willful. This penalty will be added to the assessment roll and shall be collected like any other delinquent property taxes, and be subject to the same penalties for nonpayment. for A. TRANSFER INFORMATION (Check the appropriate boxes to indicate the method by which you acquired an interest in the property.)

1. Purchase (complete Sections B and C on the reverse side). 13. Was this transfer/addition solely between spouses
   or registered domestic partners, divorce settlement, Yes No

2. Land Sales Contract. A contract for the purchase of property etc.? in which the seller retains legal title to it after the buyer takes possession. 14. Was this transaction only a correction of the name(s) of persons or entities holding title? Yes No 3. Inheritance. Transfer bySAMPLEwill or intestate succession. 15. If you hold title to this property as a joint tenant, Date of death is the seller or transferor also a joint tenant? Yes No Relationship to deceased 16. Was this transaction the termination of a joint Assessor 4. Trade or exchange. The above described property has been tenancy interest? Yes No traded or exchanged for other real property or tangible personal property. 17. Was this transfer between family members or related businesses? Yes No

3. Merger or stock acquisition. 18. Was this document recorded to substitute a trustee under a deed of trust, mortgage, or other similar

4. Partial interest transfer. Was less than 100 percent of the
   document? Yes No property transferred? If yes, indicate the percentage
   transferred %. 19. Was this document recorded to create, assign, Contact or terminate a lender’s interest in this property? Yes No

5. Foreclosure or trustee sale.
   20. Has this property been transferred to a trust? Yes No

6. Gift. If yes, is the trust: Revocable Irrevocable

7. Life estate. 21. If the trust is irrevocable, is the transferor or the
   transferor’s spouse or registered domestic Yes No
   partner t

vocable Irrevocable 9. Life estate. 21. If the trust is irrevocable, is the transferor or the transferor’s spouse or registered domestic Yes No partner the sole present beneficiary?10. Reconveyance (pay-off). 22. Does this property revert to the transferor in Yes No 11. Creation or assignment of a lease: . 12 years or less? (Clifford Trust) (date) If you answered no to 21 or 22, attach a copy of the trust12. Termination of a lease: . agreement. (date)

THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

This page watermarked sample only. BOE-502-G (P2) REV. 07 (07-25) Contact Assessor for actual form. B. PROPERTY INFORMATION (Complete each item as it applies to this transaction.)

1. Seller’s name and address:

2. Field name: Lease name: Parcel number:

3. Date sales agreement or letter of intent signed: Effective transfer date:

4. Closing date: Recording document: Number: Date:

5. Name, address and phone number of person with purchasing firm who is familiar with the transaction and would be available to answer questions relative to the transaction:

6. Name, address, and phone number of any consultants used in connection with the transaction:

7. Interest acquired (please report decimal fractions out of total; e.g., 0.875 out of 1.000). Revenue interest: Working interest: Other working interest owners & percentages:

8. Number of wells: Producing Injection All idle Other

9. Productive acres in the parcel: Total acres in the parcel:

10. Production rates at acquisition: Oil b/d Gas mcf/d Water b/d

11. Price received for oil and gas at acquisition: Oil $/b Gas $/mcf Form

12. Oil gravity: API Gas: btu/mcf Average producing depth: ft

13. Proved reserves: Developed: Oil bbl Gas mcf Undeveloped: Oil bbl Gas mcf14. Were appraisals, evaluations, cash flow projections or other analyses madeONLYto assist in establishing a purchase price? Yes No a. If yes, please enclose copies of those appraisals, evaluations, cash flow projections or analyses. Please identify the analysis or appraisal most relied upon in establishing the purchase price. Actual b. If no, please explain in Section D how the purchase price was determined.

14. Please enclose a copy of the following: a. The sales agreement or contract including all exhibits and amendments thereto, as well as other related agreements or contracts, such as loan agreements. for b. A complete listing of all assets acquired and liabilities assumed in the acquisition, if not included in item 15a. Please list each lease, including wells and related equipment, separately. c. The allocation to your company books of the total acquisition price, by specific items. C. PURCHASE PRICE OR TRANSFER AMOUNT INFORMATION Terms: Total purchase price: Cash to seller: Production and/or conventionalSAMPLEloan(s): Amount(s): Interest rate(s): Source(s) of financing (bank, seller, etc.): Purchase price allocated to: Fixed plant & equipment: Moveable equipmentD. REMARKS (Please include below anyAssessoradditional information about the sale or transfer which should be called to the attention of the Assessor.)

    CERTIFICATION

OWNERSHIP TYPE I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information herein,Proprietorship Partnership including any accompanying statements or materials, is true, correct, and complete to the best of my knowledge and belief. ThisCorporation Contactdeclaration is binding on each and every co-owner and/or partner. Other NAME OF ASSESSEE OR AUTHORIZED AGENT (typed or printed) TITLE

SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT DATE t NAME OF ENTITY (typed or printed) FEDERAL EMPLOYER ID NUMBER

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

DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS ( )