Fillable OSAGE FORM NO. 133 UNITED STATES DEPARTMENT OF (Bureau of Indian Affairs)

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OSAGE FORM NO. 133 UNITED STATES DEPARTMENT OF (Bureau of Indian Affairs)

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OSAGE FORM NO. 133
ast(white)
OIL LESSEE’S REPORT FOR MONTH OF _______________________________________ YEAR______________________________
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
SUPERINTENDENT, OSAGE AGENCY
BRANCH OF MINERALS
813 GRANDVIEW/POB 1539
PAWHUSKA, OK 74056
(918) 287-5740 FAX(918) 287-5784
LESSEE ID#__________
LESSEE NAME______________________________________________________ CURRENT PHONE#__________________________
ADDRESS______________________________________________________________________________________________________
CITY_________________________________________________ STATE_____________________________ ZIP__________________
LEGAL DESCRIPTION
OSAGE
CONTRACT #
DIVISION
ORDER #(2)
1/4
SEC.
TWP
RGE
PURCHASER
(ROYALTY
PAID BY)
BBLS. OIL
SOLD
ROYALTY
RATE
BBLS OIL
PRODUCED
#
WELLS
PRO-
DUCED
(1)
DAYS
PRO-
DUCED
DATE
LAST
PRODUCED
MO/DY/YR
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
(1) NUMBER OF OIL WELLS ACTUALLY IN OPERATION THIS MONTH.
(2) OIL PURCHASER DIVISION ORDER NUMBER
I CERTIFY THE FOREGOING REPORT IS TRUE AND CORRECT.
__________________________________________________________________________ ______________________________________________________________
SIGNATURE AND TITLE TELEPHONE NUMBER
CFR 226.26 – LESSEE SHALL FURNISH
CERTIFIED MONTHLY REPORTS BY
THE END OF EACH MONTH COVERING
ALL OPERATIONS, WHETHER THERE
HAS BEEN PRODUCTION OR NOT.
click to sign
signature
click to edit
OSAGE FORM NO. 157
ast(blue)
FOR CONSOLIDATED LEASES ONLY
OIL LESSEE’S REPORT FOR MONTH OF _______________________________________ YEAR______________________________
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
SUPERINTENDENT, OSAGE AGENCY
BRANCH OF MINERALS
813 GRANDVIEW/POB 1539
PAWHUSKA, OK 74056
(918) 287-5740 FAX(918) 287-5784
LESSEE ID#_____________
LESSEE NAME_________________________________________________ CURRENT PHONE#_______________________________
ADDRESS______________________________________________________________________________________________________
CITY __________________________________________________ STATE_____________________________ ZIP_________________
LEGAL DESCRIPTION
OSAGE
CONTRACT #
DIVISION
ORDER #(4)
1/4
SEC
TWP
RGE
PURCHASER
(ROYALTY
PAID BY)
BBLS. OIL
SOLD
(1) (3)
ROYALTY
RATE
ROYALTY
AMOUNT
(dollars)
(1) (3)
BBLS OIL
PRODUCED
(1) (3)
#
WELLS
PRO-
DUCED
(2)
DAYS
PRO-
DUCED
DATE
LAST
PRODUCED
MO/DY/YR
__________
__________
__________
__________
__________
__________
_________
__________
__________
(1) OIL AND ROYALTY FROM EACH QUARTER SECTION OF CONSOLIDATION MUST BE ACCOUNTED FOR SEPARATELY
(2) NUMBER OF OIL WELLS ACTUALLY IN OPERATION THIS MONTH.
(3) COLUMN IS TO BE TOTALED FOR EACH CONSOLIDATION
(4) OIL PURCHASER DIVISION ORDER NUMBER
I CERTIFY THE FOREGOING REPORT IS TRUE AND CORRECT.
___________________________________________________________________________ ____________________________________________________________
SIGNATURE AND TITLE TELEPHONE NUMBER
CFR 226.26 – LESSEE SHALL FURNISH
CERTIFIED MONTHLY REPORTS BY
THE END OF EACH MONTH COVERING
ALL OPERATIONS, WHETHER THERE
HAS BEEN PRODUCTION OR NOT.
click to sign
signature
click to edit
OSAGE FORM NO. 300
ast(pink)
FOR WATERFLOOD LEASES ONLY (1)
OIL LESSEE’S REPORT FOR MONTH OF _____________________________________________ YEAR________________________
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
SUPERINTENDENT, OSAGE AGENCY
BRANCH OF MINERALS
813 GRANDVIEW/POB 1539
PAWHUSKA, OK 74056
(918) 287-5740 FAX(918) 287-5784
LESSEE ID#_____________
LESSEE NAME_________________________________________________ CURRENT PHONE#_______________________________
ADDRESS______________________________________________________________________________________________________
CITY____________________________________________ STATE___________________________ ZIP_________________________
LEGAL DESCRIPTION
OSAGE
CONTRACT #
DIVISION
ORDER #(5)
(2)
¼
UNIT
SEC.
NAME
TWP
RGE
PURCHASER
(ROYALTY
PAID BY)
BBLS. OIL
SOLD
ROYALTY
RATE
(3)
ROYALTY
AMOUNT
(dollars)
BBLS OIL
PRODUCED
#
WELLS
PRO-
DUCED
(4)
DAYS
PRO-
DUCED
DATE
LAST
PRODUCED
MO/DY/YR
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
(1) This form is completed on leases approved for waterflood units by The Osage Minerals Council.
(2) Information must include name of waterflood unit and indicate the specific quarter section oil is posted to on Agency computer
(Legal description can be obtained from Branch of Minerals, 918-287-5740).
(3) If different royalty rates apply – specify rate and amount at each rate.
(4) Number of oil wells actually in operation this month.
(5) Oil Purchaser Division Order Number.
I CERTIFY THE FOREGOING REPORT IS TRUE AND CORRECT.
________________________________________________________ _________________________________
SIGNATURE AND TITLE TELEPHONE NUMBER
CFR 226.26 – LESSEE SHALL FURNISH
CERTIFIED MONTHLY REPORTS BY
THE END OF EACH MONTH COVERING
ALL OPERATIONS, WHETHER THERE
HAS BEEN PRODUCTION OR NOT
click to sign
signature
click to edit
OSAGE FORM NO. 101
(green)
METER STATION NO: _______________________________
DRY GAS REPORT FOR MONTH OF __________________________________, YEAR: ______________________
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
TO SUPERINTENDENT, OSAGE AGENCY
BRANCH OF MINERALS
813 GRANDVIEW
P. O. BOX 1539
PAWHUSKA, OK 74056
(918) 287-5740 FAX(918) 287-5784
LESSEE ID NO: _____________
LESSEE NAME:_______________________________________________ CURRENT PHONE NO: _____________________________
ADDRESS: ________________________________CITY: ___________________ STATE: _____________ ZIP: _________________
GAS PURCHASER:_______________________________________________PURPOSE: DOMESTIC/SALES/OTHER (CIRCLE ONE)
LOCATION OF METER: __________________________________________ BTU ADJUSTMENT: ___________________________
LEASE DESCRIPTION
OSAGE
CONTRACT
NUMBER
¼
SEC
TWP
RGE
ROYALTY
RATE
TYPE
OF
GAS
(1)
ROYALTY
AMOUNT
MCF
UNIT PRICE
PAID
PER/MCF
PRICE
PAID
PER
MMBTU
NO. OF
WELLS
PRO-
DUCED
DATE
LAST
PRODUCED
MO/DY/YR
(1) USE: CHG (CASINGHEAD); NG – NATURAL GAS (GAS WELL GAS); CBM – COAL BED METHANE
2. CONSOLIDATED GAS LEASES - PRODUCTION FROM EACH QUARTER SECTION OF CONSOLIDATION MUST BE ACCOUNTED FOR
SEPARATELY AND COLUMN IS TO BE TOTALED FOR EACH CONSOLIDATION.
I CERTIFY THAT THE FOREGOING REPORT IS TRUE AND CORRECT.
_____________________________________________________________________________________ ____________________________________________
SIGNATURE AND TITLE TELEPHONE NUMBE
CFR 226.26 – LESSEE SHALL FURNISH
CERTIFIED MONTHLY REPORTS BY
THE END OF EACH MONTH COVERING
ALL OPERATIONS, WHETHER THERE
HAS BEEN PRODUCTION OR NOT
click to sign
signature
click to edit
OSAGE FORM NO. 101-A
(yellow)
METER STATION NO: _______________________________
NGL GAS REPORT FOR MONTH OF __________________________________, YEAR: _____________________
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
TO SUPERINTENDENT, OSAGE AGENCY
BRANCH OF MINERALS
813 GRANDVIEW
P. O. BOX 1539
PAWHUSKA, OK 74056
(918) 287-5740 FAX(918) 287-5784
LESSEE ID NO: _____________
LESSEE NAME:_______________________________________________ CURRENT PHONE NO: _____________________________
ADDRESS: ________________________________CITY: ___________________ STATE: _____________ ZIP: _________________
NGL PURCHASER:_______________________________________________PURPOSE: DOMESTIC/SALES/OTHER (CIRCLE ONE)
LOCATION OF METER: __________________________________________ BTU ADJUSTMENT: ___________________________
PLANT LOCATION DESCRIPTION
OSAGE
CONTRACT
NUMBER
¼
SEC
TWP
RGE
ROYALTY
RATE
TYPE
OF
GAS
(1)
ROYALTY
AMOUNT
(Dollars)
Gallons
NGL
SOLD
UNIT
PRICE
Price per
Gallon
GALLON
NGL
PRO-
DUCED
DAYS
PRO-
DUCED
NO. OF
WELLS
PRO-
DUCED
(1)
DATE
LAST
PRODUCED
MO/DY/YR
1. NUMBER OF WELLS ACTUALLY IN OPERATION THIS MONTH.
I CERTIFY THAT THE FOREGOING REPORT IS TRUE AND CORRECT.
_____________________________________________________________________________________ ____________________________________________
SIGNATURE AND TITLE TELEPHONE NUMBER
CFR 226.26 – LESSEE SHALL FURNISH
CERTIFIED MONTHLY REPORTS BY
THE END OF EACH MONTH COVERING
ALL OPERATIONS, WHETHER THERE
HAS BEEN PRODUCTION OR NOT
click to sign
signature
click to edit
Paperwork Reduction Act (PRA) Statement: This information is collected to meet reporting requirements
and is subject to the PRA. An agency may not request nor sponsor, and a person need not answer a request
for information that does not display a valid OMB control no. A response to this request is required to obtain
a benefit. The public reporting burden for this form is estimated to average 30 minutes, including the time for
reviewing the instructions, gathering and maintaining data, and completing and reviewing the form. Send
comments on the burden estimate or any other aspect of this form to Information Collection Clearance
Officer–Indian Affairs, 1849 C Street, NW, MS-3642, Washington, DC 20240.
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OSAGE FORM NO. 133 UNITED STATES DEPARTMENT OF (Bureau of Indian Affairs)

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Completed 26 September 2021

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