Form 1073 - Transfer Of Operator - Single Oil Or Gas Well printable pdf download

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

Ft FSL of

Ft FWL of

County

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

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.

CURRENT

OPERATOR

NEW

OPERATOR

Name

Address

City

State

Zip

City

State

Zip

Phone

FAX No./E-mail

Phone

FAX No./E-mail

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)

Signature

Name & Title (Typed or Printed)

Signed and sworn to before me

this

day of

this

day of

Notary Public

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.

assignment, or

certified copies of a journal entry of judgment

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.

Form 1073 - Transfer Of Operator - Single Oil Or Gas Well

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