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Well No: API Well No: 43013500670000 43013500670000Received: Received: 6/30/2009 6/30/2009FORM FORM 3STATE STATE OF UTAH DEPARTMENT OF NATURAL RESOURCES DIVISION OF OIL, MINING DIVISION OIL, GAS AND

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Form W-4301 is a specific form used by the IRS for certain tax-related purposes, typically related to reporting withheld and deposited taxes.

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Entities that have withheld taxes or made deposits related to income paid to employees are required to file Form W-4301.

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To fill out Form W-4301, provide the required taxpayer information, reported amounts of taxes withheld, and deposits made during the reporting period.

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The form requires information such as the entity's identification, amounts of taxes withheld, and details of deposits made during the reporting period.

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