Form Ogb - 1e - Application For Change Of Operator

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STATE OIL AND GAS BOARD OF ALABAMA
Form OGB - 1E
420 Hackberry Lane
5 / 00
Permit number
P.O. Box 869999
01-
-
Tuscaloosa, Alabama 35486-6999
Fax (205)349-2861
(205) 349-2852
API number
Application for Change of Operator
(file in triplicate)
Name of new operator
Date
State
Zip
City
Address
Name of present operator
State
Zip
Address
City
County
Well name and number
(give footage from nearest section or tract lines)
Well
Section-Township-Range or Tract
Location
.
Longitude
Latitude
.
(surface)
(give footage from nearest section or tract lines)
Well
Section-Township-Range or Tract
Location
Longitude
Latitude
.
.
(bottom hole)
Field (if wildcat, so state)
Reservoir
Describe unit
Status of well:
Acres assigned to well
Drilling
Producing
Shut-in
Temp. Abandoned
Other (specify)
Bonding company and bond number
Single well
Amount of bond
Type
bond
Blanket
Person to contact
Phone number
regarding this
Fax number
application
E-Mail address
Remarks:
, 20
Executed this the
day of
Signature
known to me to be the person
Before me, the undersigned authority, on this day personally appeared
whose name is subscribed to the above instrument, who being by me duly sworn on oath states that he/she is duly authorized to make the above report and that he/she
has knowledge of the facts stated therein, and that said report is true and correct.
day of
, 20
Subscribed and sworn to before me this
SEAL
Notary Public in and for
County,
My commission expires
ACTION OF STATE OIL AND GAS BOARD
APPROVED BY
DATE

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