Wednesday, May 10, 2017

Transcription

1 Bob Anthony Todd Hiett Dana Murphy OKLAHOMA Corporation Commission P.O. BOX OKLAHOMA CITY OKLAHOMA OIL & GAS CONSERVATION DIVISION 255 Jim Thorpe Building Telephone: (405) FAX: (405) Tim Baker, Division Director Wednesday, May 10, 2017 Multiple Well Transfer Request: 1073MW form From: Rebellion Energy LLC, #23733 To: J & S of Enid Inc, #18201 All wells on the submitted list were approved. 11 wells were transferred SERVICE ASSISTANCE COMPLIANCE EXCELLENCE IS OUR STANDARD

2 lnstructions A. Please type or print using biack or blue ink. B. Form must be signed by former operator and new operator. C. Signatories be listed on their company's Form 1006B. D. Fill in the complete legal description on back page or successive pages. E. Direct questions to Well Records at (405) syie erkatl CURRENT OPERATOR OCC/OTC No Name Rebellion Energy LLC Address 5416 S. Yale, Ste. 300 City State Zip Tulsa OK FAX No./ l verify that l am the legal operator of record with authority to transfer operatorship of these wells, that the facts presented Wein are true and correct, and that l have completed this torm and attached all documents as required by the above instructions. No. or wells listed: 11 (Signatory must be ' Signature n companys Form 1006B Operator's Agreement) Staci Taruscio, President & CEO (918) Name & Title (Print or Type) (AC) Phone Signed and swom to before me this 1st day df May 2017 My Commission Expires:... lig-) - Notary Public mown, Awe, WilithilfStifter ITIPPAPParnt ry of111,il8a COMMVert COMMISSION p M: ' 04 ''' 0 ' IA 20 OKLAHOMA CORPORATION COMMISSION Oil & Gas Conservation Division Post Office Box Oklahoma City, Oklahoma ;VEvl OPERATOR Name Address City Transfer of Operator Mutiple Oil and/or Gas Wells OAC 165: Enid OCC/OTC No. 1 J&SofEnidlnc. P.O. Box 389 State jdws@phgglobal.net OK FAX No./ Being the new operator, as of the effective date of transfer, I accept the facts presented as being true and correct and accept the ope nal responsibility for the wells on the described Lp This form must be filed with the OCC within 30 days of transfer of the wells ProPerflf. No. of wells listed: 11 (Sign ust be list on m 's Form Operator's Agreement) Signature Name & Title (Print df Type) Signed and swom to before me this otary 1st day of blic My Commission Expires: :21 ised due diligence in attempting to locate the current operator of record according to located to obtain a signature. I have attached certified copies of the recorded lease(s) or as cy proceeding pursuant to OAC 165: (b). 5@p-z374,0isz. (AC) Phone May 2017 Form 1073MW Rev Front Page FEE: $ OAC (b)(1)(0) (SEE BACK PAGE FOR PAYMENT INFORMATION) DO NOT WRITE INSIDE THIS BOX OKLA CORP COMM RECEIPT,: Time: 1 :46 Case: 00000n000 Cashier RDZ Payor: MS OF ENID INC Check: 4206 $ WELL TRANSFER- PER The effective date of transfer is the date that the transfer is approved by the Commission. Use form to transfer 10 or more Is. Use Form 1073 A. DAMIlarglinfiin pe oil and gas wells. s, mar=.. ned the 459"4"3" Signed and sworn to before me this 1st My commission expires: Wel l Records Review: Surety MAY CORDS Approved Date MAY WELL RECORDS APPROVED By processing this Form 1073MW, the has approved the contents thereof as to form only. The does warrant that the facts provided by the operator are true. Transfer is not effective until approved by the Well Records Department. LORI A. DAUGHERTY Notary Pubic in end br the State otoldsibma Commission ili My Commission mmlase&mmoo

3 Form 1073MW Rev Back Page LIST MULI IPLE WELLS ON PAGE 3 AND SUBSEQUENT PAGgS OF THIS FORM OPERATOR NAME / NUMBER: TOTAL NUMBER OF WELLS LISTED (MUST MATCH NUMBER OF WELLS IN "SIGNATURE BOX" ON FIRST PAGE): CODES -- FOR THE WELLS ON YOUR TRANSFER LIST, SPECIFY A "WELL STATUS" CODE FROM THE CHOICES BELOW: ND (new drill), SP (spud), AC (active), TA (temporarily abandoned/not plugged), TM (terminated order/uic well not plugged) This form must be sent, along with payment, to the Cashier at either the Jim Thorpe Office Building in Oklahoma City or the OCC office in Tulsa. OKLAHOMA CITY MAILING ADDRESS: Attention: Cashiers Office P.O. Box Oklahoma City, OK (checks or money orders only) HAND-DELIVERY STREET ADDRESS: The Jim Thorpe Office Building (The Cashier is on the First Floor) 2101 N. Lincoln Blvd. Oklahoma City, OK (cash, checks or money orders only) CHECKLIST FOR WELL LIST ENTRY BY COMPUTER: TULSA MAILING ADDRESS: Attention: Court Clerk's Office 440 S. Houston Ave., Suite 114 Tulsa, OK (checks or money orders only) 1. USE "ALL CAPS" TEXT (NO "LOWER CASE" TEXT). USE SINGLE NUMBERS FOR "HALF" SECTIONS (for example, "Er). 2. SORT WELLS IN ORDER OF "LOWEST TO HIGHEST"' API NUMBER; HIGHLIGHT DATA TO SORT, THEN "SORT" IT (COLUMN HEADINGS, COLUMNS OR ROWS CANNOT BE HIGHLIGHTED OR SORTED; ONLY THE WELL DATA THAT YOU ENTERED CAN BE HIGHLIGHTED AND SORTED). 3. USE LEADING ZERO's (AS APPLICABLE) FOR SECTION, TOWNSHIP AND RANGE (i.e., 01/01N/22E). 4A. PRIMARY PRINTING METHOD: SET A "PRINT AREA" AROUND YOUR LIST OF WELLS TO ALLOW EXCEL TO CORRECTLY SET THE PAGE RANGE IN THE PRE-DEFINED "HEADER" OF THE FILE. 4B. ALTERNATE PRINTING METHOD: IF UNABLE TO SET A "PRINT AREA" -- DELETE ALL ROWS (THAT HAVE PRE-DEFINED SOLID BORDERS) BELOW THE LAST WELL YOU LISTED. THIS WILL ALLOW EXCEL TO CORRECTLY SET THE PAGE RANGE IN THE PREr)FFINFII "1-1FAI1FR" OF YOUR Fll F 5. A COURTESY COPY OF YOUR COMPLETED EXCEL FILE TO THE OCC WELL RECORDS DEPT. CALL OUR WELL RECORDS DEPT. AT (405) TO OBTAIN THE CURRENT ADDRESS. NOTE YOUR WELL LIST, NOTARIZED 1073MW FORM AND PAYMENT MUST STILL BE MAILED OR DELIVERED TO ONE OF THE ADDRESSES LISTED ABOVE.

4 OCC USE (Sort by API Number) (Use "ALL CAPS" text) 10-Digit API Number (NO DASHES) (NO SUFFIXES) Well Name (UPPER CASE letters only) Well Class: ( Well Status: ( Well #(letters: SEC TWP RGE (i.e. (, Qtr Qtr Qtr Qtr UPPER CASF) 02N) Of ) ) ) ALL CAPS) (ALL CAPS,1'.:( (ALL CAP S, 2 PER CASE LE TT ERS)? If not, leave blank. Form 1073MW, Page 1 of WV" COMMENTS Print these forms in" [ I '( )(1orizontal)orientation nly V BURSHIK 2-5 OIL AC 05 18N 05W NW4 SW4 NW4 V CAIN 3-7 OIL AC 07 18N 05W CNI/W SE4 I,/ NELSON 3-8 OIL AC 08 18N 05W SE4 NW4 SW4 V O'HERN 1 OIL AC 17 18N 05W NE4 NE4 / CAIN 1 OIL AC 07 18N 05W CNE4 SE4 V" GALLUP 1, OIL AC 07 18N 05W CNE4 SW4 / GALLUP MIA-7- OIL AC 07 18N 05W CNE4 NW4 (// NELSON ''C" C-- ).1-8- OIL TA 08 18N 05W CNE4 SW4 V O'HERN 2 OIL AC 17 18N 05W SW4 NE OTTO THARP 2. OIL AC 05 18N 05W NE4 SW4 / OTTO THARP 1. OIL AC 05 18N 05W CSW4 NE4

5 Janie Hlinicky From: Sent: To: Attachments: Janie Hlinicky Wednesday, May 10, :31 PM Rebellion mass transfer_ pdf To Whom It May Concern, We have approved the transfer of the 11 wells on the attached 1073MW from Rebellion Energy LLC (23733) to J & S of Enid Inc (18201). Sincerely, Janie Hlinicky Well Records Section Phone: Fax: j.hlinickv@occ .com There are new forms for transfers for single well, 1073MW for 10+ wells, for single injection well, 10731MW for 10+ injection wells. Fees for transfers went into effect August 25, The amounts of the fees are on the forms. 1