Form 1073mw - Transfer Of Operator - Transfer Of Operator printable pdf download

Instructions

OKLAHOMA CORPORATION COMMISSION

This form must be filed with the

Form 1073MW

A. Please type or print using black or blue ink.

Oil & Gas Conservation Division

OCC

within 30 days of transfer

New 2016 - Front Page

of the wells.

B. Form must be signed by former operator and new operator.

Post Office Box 52000

C. Signatories

must

be listed on their company's Form 1006B.

Oklahoma City, Oklahoma 73152-2000

FEE:

$250.00

D. Fill in the complete legal description on back page or successive pages.

E. Direct questions to Well Records at (405) 521-2271.

Transfer of Operator

OAC 165:5-3-1(b)(1)(O)

Mutiple

Oil and/or Gas

Wells

(SEE

BACK PAGE

FOR

OAC 165:10-1-15

PAYMENT

INFORMATION)

OCC/OTC No.

DO NOT WRITE INSIDE THIS BOX

CURRENT

OPERATOR

NEW

OPERATOR

Name

Address

City

State

Zip

City

State

Zip

FAX No./E-mail:

I verify that I am the legal operator of record with authority to transfer operatorship of these wells,

Being the new operator, as of the effective date of transfer, I accept the facts presented as

that the facts presented herein are true and correct, and that I have completed this form and

being true and correct and accept the operational responsibility for the wells on the described

attached all documents as required by the above instructions.

property.

No. of wells listed:

(Signatory must be listed on company's Form 1006B Operator's Agreement)

Signature

The

effective date of transfer

is the

date that

Name & Title (Print or Type)

(AC) Phone

Name & Title (Print or Type)

(AC) Phone

the transfer is approved

by the Commission.

Signed and sworn to before me this

day of

Signed and sworn to before me this

day of

Use

this

form to transfer

10 or more

Notary Public

oil or gas wells. Use

Form 1073

My Commission Expires:

to transfer

single

oil and gas wells.

I verify under oath that I have exercised

due diligence

in attempting to locate the current operator of record according to OCC records, who has

abandoned

the

I have attached

certified copies of the recorded lease(s) or

assignment(s),

certified copies of a

above wells/leases and

cannot be located

to obtain a signature.

journal entry of judgment

bankruptcy proceeding

pursuant to OAC 165:10-1-15(b).

Signature

Signed and sworn to before me this

day of

Notary Public

My commission expires:

FOR OCC USE ONLY

Surety

Approved Date

By processing this Form 1073MW, the Oklahoma Corporation Commission has approved the

contents thereof as to

form

only. The Oklahoma Corporation Commission does

not

warrant that

the

facts provided by the operator

are true.

Well

Records

Transfer is

not effective until approved

by the

Well Records

Department.

Review:

Form 1073mw - Transfer Of Operator - Transfer Of Operator

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