Form 2 - Mississippi Oil And Gas Board 2010

Download a blank fillable Form 2 - Mississippi Oil And Gas Board 2010 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 2 - Mississippi Oil And Gas Board 2010 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

MISSISSIPPI STATE OIL AND GAS BOARD

APPLICATION FOR PERMIT TO DRILL, WORKOVER OR CHANGE OPERATOR

FORM No. 2

APPLICATION TO DRILL

WORKOVER

CHANGE OF OPERATOR

NAME OF COMPANY OR OPERATOR

DATE

ADDRESS

CITY

STATE

ZIP

TELEPHONE

NAME OF WELL

WELL NO.

ELEVATION (GROUND)

CHECK TYPE OF

PROPOSED WELL

WELL LOCATION (WHEN POSSIBLE, GIVE FOOTAGE FROM SECTION LINES)

SECTION – TOWNSHIP - RANGE

OIL

GAS

OTHER (NAME)

LATITUDE – LONGITUDE (NEW WELLS) (dd.ddddd)

SECTION

TOWNSHIP

RANGE

FIELD & RESERVOIR (IF WILDCAT, SO STATE)

API No. (EXISTING WELL)

APPROX. DATE WORK

BEGINS

COUNTY

PROPOSED DEPTH

PROPOSED LENGTH OF SURFACE

NUMBER OF ACRES IN

DISTANCE FROM

DISTANCE FROM PROPOSED LOCATION TO NEAREST

CASING

RILLING UNIT

PROPOSED LOCATION

DRILLING, COMPLETED OR APPLIED FOR WELL

_______________

FEET _________________

FEET

__________________ ACRES

_________________FEET

_____________________________________FEET

NAME OF DRILLING CONTRACTOR

ADDRESS

CITY

STATE

ZIP

FOR CHANGE OF OPERATOR ONLY - SIGNATURE OF FORMER OPERATOR REQUIRED FOR TRANSFER OF WELL

AUTHORIZED REPRESENTATIVE SIGNATURE

NAME OF FORMER OPERATOR

NOTE: AREA FIELD INSPECTOR OR FIELD DIRECTOR (JACKSON OFFICE) OF DATES OF SPUDDING AND REACHING TOTAL DEPTH.

M i s s i s s i p p i State Oil and Gas Board, 500 Greymont Avenue, Suite E, Jackson, MS 39202 601-576-4900

REMARKS: (IF THIS IS AN APPLICATION TO WORKOVER, BRIEFLY DESCRIBE WORK TO BE DONE, GIVING PRESENT PRODUCING ZONE AND EXPECTED NEW PRODUCING ZONE)

ARE THERE SEPARATELY OWNED TRACTS OR

IF YES, HAVE THE PERSONS OWNING THE DRILLING RIGHTS IN SAID TRACTS OR INTERESTS AND

YES

INTERESTS IN THE DRILLING UNIT FOR WHICH THIS

THE RIGHTS TO SHARE IN THE PRODUCTION THEREFROM AGREED TO DEVELOP THEIR LANDS AS

PERMIT IS SOUGHT? (REF. MS. STATUTE 53-3-7)

A DRILLING UNIT AND TO THE DRILLING OF THE WELL? (REF. MS. STATUTE 53-3-7)

EXECUTED THIS THE ______________________________ DAY OF ____________________________________________________________________________, 20 _____

STATE OF __________________________________________

COUNTY OF ___________________________________________

SIGNATURE OF AFFIANT_______________________________________________

BEFORE ME, THE UNDERSIGNED AUTHORITY, ON THIS DAY PERSONALLY APPEARED

KNOWN TO ME TO BE THE PERSON WHOSE NAME

IS SUBSCRIBED TO THE ABOVE INSTRUMENT, WHO BEING BY ME DULY SWORN ON OATH, STATES THAT HE IS DULY AUTHORIZED TO MAKE THE ABOVE REPORT AND THAT HE HAS

KNOWLEDGE OF THE FACTS STATED THEREIN, AND THAT SAID REPORT IS TRUE AND CORRECT.

SUBSCRIBED AND SWORN TO BEFORE ME THIS ______________________ DAY OF _______________________________________________________________________, 20 _________

SEAL

Signature____________________________________________________________________

NOTARY PUBLIC IN AND FOR __________________________

_____________

MY COMMISSION EXPIRES __________________________________ ________

COUNTY

M I SSI SSI PPI STATE OI L AND GAS BOARD

PERMIT NUMBER_____________________________________________________________________

FORM 2 ( Rev. 5/ 10)

A. P. I . W ELL NUM BER

APPROVAL DATE_____________________________________________________________________

STATE