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OP-77
(05-01) |
Record
No. _________ |
State
of West Virginia
Department
of Environmental Protection
Charleston,
WV 25301
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This
is to acknowledge that the well: API no. |
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District |
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Well No |
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Farm name |
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Is hereby transferred
from:
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The transferor |
Company: |
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Code # |
Address |
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To:
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The transferee |
Company: Mountain State Natural Gas Recovery |
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Code # |
Address PO. Box 143 jesse, west Virginia 24849 |
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Transfer
approval and responsibility for any noncompliance matter not resolved in this
document will be addressed in the thirty day circular that will be issued
after review of your application for transfer, or as otherwise set forth by
agreement with the Chief.
If
this well has been out of production for the period in excess of 12 months, the
transferee agrees to bring the well into compliance by producing or plugging
within 120 days of approval of the application. __ Yes__ No
The transferee has registered and designated an
agent on form OP-1, which is on file with the Office of Oil and Gas. The agent
is:
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Designated agent (name) |
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Address: |
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The
transferee has bonded the said well by ( check one ):
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Securities |
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Cash |
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Surety bond |
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Letter of credit |
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Identified
by:
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Amount: |
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Effective date : |
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Issuing authority: |
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Id. No: |
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Transferor: _____________________________________
By: ___________________________________________
Its:____________________________________________
Taken,
subscribed and sworn before me this ___________ day of ___________
19___
Notary
Public ___________________________________________________________
My
Commission Expires ____________________________________________________
Transferee:______________________________________
By: ___________________________________________
Its:____________________________________________
Taken,
subscribed and sworn before me this ___________ day of ___________
19___
Notary
Public ___________________________________________________________
My Commission Expires ____________________________________________________
www.msngr.org