DEP Oil&Gas Form 1 "Organization Report" - Florida

DEP Form Oil&Gas1 or the "Organization Report" is a form issued by the Florida Department of Environmental Protection.

The form was last revised in March 1, 1998 and is available for digital filing. Download an up-to-date DEP Form Oil&Gas1 in PDF-format down below or look it up on the Florida Department of Environmental Protection Forms website.

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Download DEP Oil&Gas Form 1 "Organization Report" - Florida

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Oil & Gas Form 1
Florida
ORGANIZATION REPORT
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by reference:
Rule 62C-25.008
All persons exploring for, storing, transporting, reclaiming, treating, or processing crude oil or natural gas shall file this record
with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588,
Tallahassee, Florida 32399-2400 (phone 850/245-8336) Or, Email: OGP@dep.state.fl.us
1. Organization: ___________________________________________________________________________________
(Name and Address)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Phone Number: __________________________________ Fax Number: ___________________________________
2. Type of Organization: _
___________________________________________________________________________
(Corporation, Joint Association, Firm, Partnership, Individual, etc.)
3. Purpose of Organization: _________________________________________________________________________
4. If Corporation, State and Date of Incorporation:
__
_____________________________________________________
Name and Address of Florida Registered Agent:
_______________________________________________________
Date Registered with Secretary of State: _____________________________________________________________
5. Officers, Owners, Directors and Trustees Information
:
(Attach additional sheets as needed)
Name
Title
Address
Phone Number
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Is this a reorganization? ________ If so, previous name: _______________________________________________
Oil & Gas Form 1
Florida
ORGANIZATION REPORT
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by reference:
Rule 62C-25.008
All persons exploring for, storing, transporting, reclaiming, treating, or processing crude oil or natural gas shall file this record
with the Florida Department of Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588,
Tallahassee, Florida 32399-2400 (phone 850/245-8336) Or, Email: OGP@dep.state.fl.us
1. Organization: ___________________________________________________________________________________
(Name and Address)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Phone Number: __________________________________ Fax Number: ___________________________________
2. Type of Organization: _
___________________________________________________________________________
(Corporation, Joint Association, Firm, Partnership, Individual, etc.)
3. Purpose of Organization: _________________________________________________________________________
4. If Corporation, State and Date of Incorporation:
__
_____________________________________________________
Name and Address of Florida Registered Agent:
_______________________________________________________
Date Registered with Secretary of State: _____________________________________________________________
5. Officers, Owners, Directors and Trustees Information
:
(Attach additional sheets as needed)
Name
Title
Address
Phone Number
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Is this a reorganization? ________ If so, previous name: _______________________________________________
============================================================================================
Organization’s Statement
State: ________________________________
County:
__
_____________________________
I,
am th e
_____________________________________________________,
__________________________________________________________
(Name)
(Title)
Of
and attest that all information contained herein is true and correct.
___________________________________________________
(Organization)
Signature: ____________________________________
Date: ________________________________________
DEP 51-001(16)
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