U.S. Department of the Interior
Office of Natural Resources Revenue
Exempt from the Paperwork Reduction Act of 1995
Requesting Only Identifying Information and Certification
See 5 CFR 1320.3(h) (1-1-01 Edition)
Addressee of Record Designation for Service of Official Correspondence
Form ONRR-4444
Please see the Instructions for Form ONRR-4444 in a separate document.
New Modification
Effective Date:
Company Name:
Payor Code or Operator Number:
Please mark the correspondence type(s) with which the address below is being associated:
Royalty Reporting (Form ONRR-2014)
Invoices: Interest (INT)
Production Reporting (Forms ONRR-4054 and
ONRR-4058)
Invoices: Rights of Way/Use and Easement
(ROW/RUE)
Solid Minerals P&R (Form ONRR-4430)
Invoices: Financial terms (FIN)
Inspection Fees – Drilling Rigs
Invoices: Indian Over-recoupment (IOR)
Inspection Fees – Fixed Facility
Debt Collection
Audit Correspondence
Enforcement (OTH)
Address of Record (for the function(s) checked above):
Line 1:
Line 2:
City:
State: Zip code:
Person to contact as Addressee of Record:
and/or
Position/Title designated as Addressee of Record:
Phone:
Ext:
Fax:
Email Address:
Name and title of the company official
authorizing this Addressee designation:
Signature:
Date:
Print Form
click to sign
signature
click to edit
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