FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)This presentation will assist you in the completion of the Form 1021A. The hardship well application (limited deviation rule).

Date of Last Revision: 2001

Rule Requirement: 10-17-12(h)

Explanation of Form: The applicant shall file Form 1021A and the necessary attachments with the Technical Services Department for review prior to any hearing for deviation from the priority gas rules. In addition, a formal application for hearing must be filed with the Court Clerk's Office of the Commission. [Reference 165:10-17-12]

Question concerning this Form: For more information contact the Geology Department at (405) 521-6044.

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OPERATOR’S NAME

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OTC/OCC OPERATOR NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

MAILING ADDRESS, PHONE NUMBER, CITY, STATE, AND ZIP CODE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PIPLINE COMPANY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OTC/OCC NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PHONE NUMBER OF PIPELINE COMPANY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LEASE NAME AND NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

API NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OTC PRODUCTION UNIT NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LEGAL LOCATION – include quarter section calls, section, township, range and the county where the well is located

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

TYPE OF COMPLETION

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

ORDER NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

DATE OF ORDER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

TOTAL DEPTH

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

COMPLETION DATE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

DATE OF 1ST SALES

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PRODUCING ZONE(S)

ALL OF THE DATA CONCERNING THE LEASE MATCH WITH THE INFORMATION PROVIDED ON THE FORM 1002A

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PERFORATIONS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

SPECIAL ALLOCATED POOL

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

FIELD NAME

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

POOL NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

CLASSIFICATION ON FORM 1002A

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - DATE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST – Gas (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST – Oil (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST – Water (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST – GOR (Gas/Oil Ratio)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - SITP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - FTP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - BHP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - Actual

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

INITIAL TEST - Calculated

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - Date

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST – Gas (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST – Oil (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST – Water (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST – GOR (Gas/Oil Ratio)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - SITP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - FTP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - BHP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - Actual

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

LATEST TEST - Calculated

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PRODUCTION HISTORY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

CUMULATIVE PRODUCTION AS OF (Give Date)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

GAS (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OIL (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

REMAINING RESERVES AS OF (give Date)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

GAS (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OIL (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

METHOD OF CALCULATING RESERVES (attach a copy of calculations or curve)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

AVERAGE PIPELINE PRESSURE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

IS COMPRESSION NECESSARY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

ARE THE WELLS IN THE AREA BEING PRODUCED RATABLY (IF NOT, EXPLAIN)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

PRODUCTION PROBLEMS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

WAS THE PIPELINE AND OFFSET OPERATORS NOTIFIED OF HEARING

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

NET REV. INT. TO WORKING INTEREST

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

NET PRICE RECEIVED PER MCF

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

NET PRICE RECEIVED PER Bbls

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

TOTAL GROSS INCOME FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

AVERAGE GROSS INCOME PER MONTH

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

OPERATIONAL COSTS FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

NET MONTHLY AVERAGE INCOME FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

REMARKS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

BE SURE AND INCLUDE ALL OF THE FOLLOWING

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

FOR OCC USE ONLY – Do not write below this line