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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Taxpayer Name and Federal EIN or SSN in the designated fields. This information is crucial for identifying your claim.
- Fill in the Date of this Claim, along with your Contact Name, Title, and Telephone Number to ensure proper communication regarding your submission.
- Provide details about the Geophysical, Geological, or Exploration Well Project, including its Name and Location, as well as the expected Completion Date.
- In the Lessor Information section, input the Federal EIN, Name of Lessor, Contact Name, Title, Mailing Address, City, State, Email, Phone Number, Fax Number, and Zip Code.
- Acknowledge the data disclosure requirements by selecting 'Yes' or 'No' and provide your Signature of Lessor along with your Printed Name and Date.
- If applicable, indicate if this form was previously submitted for the same project by providing the date it was submitted.
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