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

What Is DEP Oil&Gas Form 1?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 1998;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEP Oil&Gas Form 1 by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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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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