lnstructions
A. Please type or print using black or blue ink.
B. Form must be signed by former operator and new operator.
C. Signatories must be listed on their companys Form 1006B.D.
Fill in the complete legal description on back page or successive
pages.
E. Direct questions to Well Records at (405) 521-2271.
bc-(-4A-) 0144--OCC/OTC
CURRENT OPERATOR aN
b 9 i 5Name Ma :a f) LI- C•-•
Address f.) 0 j if).:10 0k. st itg,
City ci State Zip ,s.. e— itr1,1 rib I c...., O 10.1411 11
Wi
FAX No./E-mail: ty) 5..." 3- A j_r_...C.. p (*" ss •,.., r
,tyvtri i ... CI fortl verify that l am the legal operator of
record with authority to transfer operatorship of these wells,
that the facts presented herein are true and correct, and that l
have completed this form and
attached all documents as required by the above
instructions.
No. of wets listed: 6:0
(Signatory must be listed on companys Form 1006B Operator's
Agreement)
\r'ir\:40--C.V•rj7C-•~CSignature 4 6.1 —3 g t, :-
M I VItti N lAWEA Itfit/1x,, k..,,T,ce.. ,2,2-41.Vftf,„a.Name
Viii4P.rirtsoill,/ i (AC) Phone
SO qlriitte_i_bgto 4> etth day of gil . POV1r,Ac( i'l
)rois,
;. 0 ..401 AR Y.'„ S \ I. : -. 1... x 1.01) 1 ' a# 04008446 1
Stae.rublic Nitgkisl-roV1119204:, f....,: Lit 1, ka
Vr..INt's49),.v0
joultriebrOfofA
OKLAHOMA CORPORATION COMMISSIONOil & Gas Conservation
Division
Post Office Box 52000Oklahoma City, Oklahoma 73152-2000
Transfer of Operator
Muth:4e 011 and/or Gas WellsOAC 165:10-1-15
This form must be filed with theOCC within 30 days oftransfer of
the wells.
OCC/OTC No.NEW OPERATOR -a:14 0 30Name PrV— S Q usak,so
L,L,c,Address li,„ , c) I i , zsi,1/4. t i k 1
City ov..),A,k , sts, , Zip\
,.,...., 1"%iiVIN „. 1 Li LiLt '1
FAX No./E-mail: klel Yvia %Or e-ki e Ma Uwe. y (0CleNeii CC'
04Being the new operator, as of the effective date of transfer, l
accept the facts presented as
being true and correct and accept the operational responsibility
forthe wells on the described
property.No. of wells listed: G
(Signatory must be listed on 's Form 1006B Operators
Agreement)
--We--.'ilSignature
ri, ft r Iti M 6 \n"c;-1.t.„, -, 91% -1)St...- 351-`1Narne &
TO,Ifittimihr) (AC) Phone
tiwort$4iis day o timie, 401--1Si4..sik N . 4.,
,... 0 ....„..„ , # ,‘Z ".051"."A4".P-IP ' ii% ..Notar ii u • c
4.s44e. 3 .., p .„'"0,# raii•tiammiSSIOla tpires=
.n.r, 0.1ansi .
ve exercised due diligence in attemp :kikkpate the
curer"ctiannot be located to obtain a signature I
Wa4te)ttacliVek.
t or bankruptcy proceeding pursuant to OAC165:(13)2/45(4F
/rsit00
Signed and sworn to before me this
My commission expires:
day of
✓
Form 1073MW
Rev. 2017 - Front Page
FEE: $250.00OAC 165:5-3-1(b)(1)(0)
(SEE BACK PAGE FOR
PAYMENT INFORMATION)
DO NOT WRITE INSIDE THIS BO)C,...-fx
05/1:L1201rCase Or30000000
Check: 1218Payo?
58 le
The effective date of transfer is the date thatthe transfer is
approved by the Commission.
Use this form to transfer 10 or moreoil or gas wells. Use Form
1073to transfer single oil and gas wells.
tor of record according to OCC records, who has abandoned theof
the recorded lease(s) or assignment(s), or certified copies of
a
Signature
FOR OCC USE ONLY
Surety Approved Date
WellRecords MAY 15 2017 MAY 15 2017
Review: WELL RECORDS
,,;;;.: APPROVED
Notary Public
By processing this Form 1073MW, the Oklahoma Corporation
Commission has approved thecontents thereof as to form only. The
Oklahoma Corporation Commission does not warrant
that the facts provided by the operator are true.
Transfer is not effective until approved by the Well Records
Department.
If unable to print correctly, click "Page Layout" & decrease
"Scale (try 85% first) then try it again
Use this form to transfer 10 or more wells. Use Form 1073 to
transfer single oil or gas wells.
Print this form in "Landscape" (wide) (horizontal) orientation
only.
umn'PT I709730n15
Time: i0:20Cashier: ROZ
M SQUARED LLC .$250.00
TRANSFER-OPER
Form 1073MWRev. 2017 - Back Page
LIST MULTIPLE WELLS ON
PAGE 3 AND SUBSEQUENTPAGES OF THIS FORM
OPERATOR NAME / NUMBER:
f; LL'I- /G-0,9 15
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:
Oklahoma Corporation Commission
Attention: Cashier's OfficeP.O. Box 52000
Oklahoma City, OK 73152-2000
(checks or money orders only)
HAND-DEUVERY STREET ADDRESS:
The Jim Thorpe Office Building
(The Cashier is on the First Floor)2101 N. Lincoln Blvd.
Oklahoma City, OK 73105
(cash, checks or money orders only)
TULSA MAILING ADDRESS:
Oklahoma Corporation CommissionAttention: Court Clerk's
Office440 S. Houston Ave., Suite 114
Tulsa, OK 74127
(checks or money orders only)
CHECKLIST FOR WELL LIST ENTRY BY COMPUTER:
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 YOUENTERED 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 PAGERANGE 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 SOLIDBORDERS) BELOW THE
LAST WELL YOU LISTED. THIS WILL ALLOW EXCEL TO CORRECTLY SET THE
PAGE RANGE IN THE PRE-DEFINED "HEADER" OF YOUR FILE
5. E-MAIL A COURTESY COPY OF YOUR COMPLETED EXCEL FILE TO THE
OCC WELL RECORDS DEPT. CALL OUR WELL RECORDSDEPT. AT (405) 521-2271
TO OBTAIN THE CURRENT E-MAIL ADDRESS.
NOTE
YOUR WELL LIST, NOTARIZED 1073MW FORM AND PAYMENT MUST STILL
BEMAILED OR DELIVERED TO ONE OF THE ADDRESSES LISTED ABOVE.
OCC USE
I
10-Digit API Number(NO DASHES)(hg) SUFFIXES)
• • •
Well Name (UPPER CASE letters only)
Well #(le tters:
Well
Class:(OIL,
Well
Status:(ND. SP,
SEC TWP(i.e.
RGE(i.e.
4,s2 gii-, i Qtr Qtr Qtr Qtr
UPPERCASE)
GAS or
DRY)AC, TA
or TM)02N)05E)
.1
ci (‘'0 :
COMMENTS
(ALL CAPS) (ALL CAPS) [ REQUIRED ] (ALL CAPS) (UPPER CASE
LETTERS)
PR I N T THESE FORMS IN 'LANDSCAPE" (WIDE) (HORIZONTAL)
ORIENTATION ONLY. FAILURE TOCOMPLY WILL RESULT IN YOURFORM
BEINGREJECTEIL
. . . DO NOT OMIT ANY BORDER LINES — THEY ARE CRUCIAL TO TNE
PROCESSING OF YOUR FORM. FAILURETOCOMPLY WLLRESULT INYOURFORM BEING
REJECTED. ::.
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