* name and address of the operator;
* common name of the production unit and the number assigned to the production unit by the prior first purchaser;
* a statement by the operator that he or she will promptly notify the first purchaser in the event that the well becomes subject to the tax imposed by the Tax Act; and
* a statement by the operator that the production unit is exempt from the tax imposed by the Tax Act.
Ill. Admin. Code tit. 86, § 475.130