Instructions
This form must be filed with the
OKLAHOMA CORPORATION COMMISSION
Form 1073
OCC
within 30 days of transfer
A. Please type or print using black or blue ink.
Oil & Gas Conservation Division
Rev. 2016
of the well.
B. Form must be signed by former operator and new operator.
Post Office Box 52000
Oklahoma City, OK 73152-2000
C. Signatories
must
be listed on their company's Form 1006B.
FEE:
$25.00
Transfer of Operator
D. Fill in the complete legal description below.
OAC 165:5-3-1(b)(1)(N)
E. Direct questions to Well Records (405) 521-2271.
Single
Oil or Gas
Well
OAC 165:10-1-15
(SEE
BACK PAGE
FOR
PAYMENT
INFORMATION)
DO NOT WRITE INSIDE THIS BOX
API No.
OTC Prod.
Unit No.
Rge.
Surface
Sec.
Twp.
Location
1/4
1/4
1/4
1/4
Ft FSL of
Ft FWL of
County
Qtr Sec
Qtr Sec
Current Well
Name/Number
Original Well
Name/Number
Unit Name
(if applicable)
Well Class:
OIL
GAS
DRY
Use this form to transfer single oil or gas wells only. Use Form 1073MW to transfer 10 or more wells.
Specify a
well status:
(see back
page)
Producing
ND
SP
AC
TA
TM
formation(s)
The
effective date of transfer
of this well, for the purposes of Commission records,
is the
date that the transfer is approved
by the Commission.
OCC/OTC No.
OCC/OTC No.
CURRENT
OPERATOR
NEW
OPERATOR
Name
Name
Address
Address
City
State
Zip
City
State
Zip
Phone
FAX No./E-mail
Phone
FAX No./E-mail
No.
No.
I verify that I am the legal operator of record with authority to transfer
Being the new operator, as of the effective date of transfer,
operatorship of this well, that the facts presented herein are true and correct,
I accept the facts presented as being true and correct and accept the
and that I have completed this form as required by the above instructions.
operational responsibility for the well on the described property.
(Signatory must be listed on company's Form 1006B Operator's Agreement)
(Signatory must be listed on company's Form 1006B Operator's Agreement)
Signature
Signature
Name & Title (Typed or Printed)
Name & Title (Typed or Printed)
Signed and sworn to before me
Signed and sworn to before me
this
day of
,
.
this
day of
,
.
Notary Public
Notary Public
My commission expires:
My commission expires:
I verify under oath that I have exercised
due diligence
in attempting to locate the current operator of record according to OCC records,
I have attached a
certified copy of the recorded lease
who has
abandoned
the listed well/lease and
cannot be located
to obtain signature.
or
assignment, or
certified copies of a journal entry of judgment
or
bankruptcy proceeding
pursuant to OAC 165:10-1-15(b).
Signature
day of
,
.
Signed and sworn to before me this
Notary Public
My commission expires:
FOR OCC USE ONLY
Surety
Approved Date
By processing this Form 1073, the Oklahoma Corporation
Commission has approved the contents thereof as to
form
only. The
Oklahoma Corporation Commission does
not
warrant that the
facts
Well
provided by the operator
are true.
Records
Review:
Transfer is
not effective until approved
by the
Well Records
Department.