Form Uic 13 – Fill Out and Use This PDF

Form Uic 13 is a Government generated Unique Identification Code that assists in the safe sharing of various financial personal details among institutions to simplify the verifications process. It enables data dealers such as banks and similar agencies to distinctly measure individual transactions on exchanges and makes previous information easily accessible anytime, anyplace. This feature further helps in preventing Identity Theft to secure credible authenticity of users which ultimately empowers protection and more meaningful communications. Hence, Form Uic 13 has emerged as an reliable online solution for carrying out a range of security centric necessities with trustworthiness.

Form Uic 13 PDF Details

Form UIC 13 is an important form that all Illinois employers must complete to report employee wages and other compensation information to the Illinois Department of Employment Security (IDES). This form is due by the last day of the month following the calendar quarter in which wages were paid. Completing this form accurately and on time is essential to ensure that your business remains in compliance with state law. Filing late or submitting incorrect information can result in significant penalties. For more information on Form UIC 13, please visit our website or contact us at (800) 893-9645. Thank you for your attention to this important matter!

Question	Answer
Form Name	Form Uic 13
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	UIC13 salt water disposal agreement form

Form Preview Example

COMMUNITY SALTWATER DISPOSAL SYSTEM APPLICATION

MAILING ADDRESS: OFFICE OF CONSERVATION INJECTION & MINING DIVISION P.O. BOX 94275-CAPITOL STATION BATON ROUGE, LA 70804-9275

PHYSICAL ADDRESS: OFFICE OF CONSERVATION INJECTION & MINING DIVISION 617 N. THIRD ST., SUITE 817 BATON ROUGE, LA 70802

UIC-13

PLEASE READ APPLICATION PROCEDURES

TYPE ONLY

OPERATOR INFORMATION

1.	OPERATOR NAME:				2. OPERATOR CODE:
	ADDRESS:
	CITY, STATE, ZIP:	,
	CITY, STATE, ZIP:	,			3.	PHONE:		FAX:
					3.	PHONE:		FAX:
	EMAIL:

				WELL INFORMATION

4.	PROPOSED COMMUNITY WELL NAME AND NUMBER:				5.	SERIAL NO. (CONVERSION & RE-PERMIT ONLY)
	WELL NO.

6.	FIELD:		7. PARISH:		8.	SEC.	TWP.		RNG.

FLUID SOURCE LIST

Provide the following information for each producing well that will be utilizing the above-listed community disposal well and system. Check if continue on back:

OPERATOR

WELL NAME & NO.

SERIAL NO. BBL SW/ MO.

TRANSPORTATION BY
TRUCK	PIPELINE	OTHER

CERTIFICATION BY OPERATOR

I	(COMPANY OFFICIAL)	,	(TITLE)	,

hereby certify that the information contained herein is accuratE and complete to the best of my knowledge. I further certify that the community disposal well(s) and system identified above is a noncommercial operation and that operators using the system share only in the cost of operating and maintaining the well(s), related storage tanks, and equipment. Attached to this document are copies of operating agreements with each of the operators wanting to utilize the above-referenced well for disposal of produced saltwater.

10.	NAME (PRINT):		11.	PHONE:
12.	SIGNATURE:	13.		DATE:

FORM UIC-13

http://dnr.louisiana.gov/cons/documents.ssi

Rev. 07/09

INSTRUCTIONS

1.Submit the non-refundable application fee per LAC 43:XIX.Chapter 7.

2.Form UIC-13 must be completed and submitted to the Injection and Mining Division for review and approval before a well may be utilized as a Community Saltwater Disposal Well.

3.For each producing well identified in the Fluid Source List, indicate which method of transportation is used to transport the saltwater to the community well.

4.Sign and date the certification at the bottom of the form prior to mailing to the following address:

Office of Conservation

Injection and Mining Division

P O Box 94275

Baton Rouge, Louisiana 70804-9275

5.Attach a copy of each operating agreement for each operator wishing to utilize the community disposal well and system. Each agreement must be signed by both parties.

* * * * * * * * * * * * * * * * * * *

(Continued from front)

OPERATOR

WELL NAME & NO.

SERIAL NO.

BBL SW/ MO.

TRANSPORTATION BY

TRUCK

PIPELINE

OTHER