DNR OOGRM Form OG-26A Plugging Program (Prf) Well Transfer Request - Illinois

DNR OOGRM Form OG-26A or the "Plugging Program (prf) Well Transfer Request" is a form issued by the Illinois Department of Natural Resources - Office of Oil and Gas Resource Management.

Download a PDF version of the DNR OOGRM Form OG-26A down below or find it on the Illinois Department of Natural Resources - Office of Oil and Gas Resource Management Forms website.

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OG-26A
Office of Oil and Gas Resource Management
PLUGGING PROGRAM (PRF)
One Natural Resources Way
Springfield, IL 62702-1271
WELL TRANSFER REQUEST
(217) 782-7756
TRANSACTION # ______________
WELL INFORMATION
REFERENCE #: _______________________ PERMIT #: __________________________ DATE ISSUED: ________________________
WELL NAME: __________________________________________________________________________ WELL #: _____________
LOCATION: _______________________________________________________________________________________________________
SECTION: ______ TOWNSHIP: ________ (NORTH/SOUTH) RANGE: ________ (EAST/WEST) COUNTY: ____________________
LEASE / UNIT INFORMATION:
TOTAL NUMBER OF WELLS IN TRANSFER: __________________ CURRENT PERMITTEE #: _____________________
LEASE / UNIT NAME: __________________________________________
LEASE / UNIT LEGAL DESCRIPTION (ATTACH LEGAL DESCRIPTION OR MAP IF NECESSARY AND ATTACH WELL
LIST AS INSTRUCTED ON REVERSE SIDE.)
NEW PERMITTEE:
UNDER PENALTIES OF PERJURY, THE NEW PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE NEW PERMITTEE HAS THE RIGHT, PURSUANT TO VALID AND SUBSISTING OIL
AND GAS LEASES, DOCUMENTS, OR MEMORANDA OF PUBLIC RECORD, AND/OR STATUTE
OR REGULATION, TO OPERATE THE WELL(S) DESCRIBED HEREIN; AND
b) THAT THE NEW PERMITTEE HAS REVIEWED THIS TRANSFER REQUEST TOGETHER WITH
ANY ACCOMPANYING STATEMENTS AND DOCUMENTS AND STATES THAT TO THE BEST
OF THE NEW PERMITTEE’S KNOWLEDGE, THE REQUEST, STATEMENTS, AND DOCUMENTS
ARE TRUE AND CORRECT.
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _______________________________________________________________________________________________________
__________________________________________________________________
__________________________________________
PRINT NAME
TITLE
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
In conjunction with the final approval of the transfer request and the payment of the well salvage value of $____________(calculated
from the reverse side of this form) and pursuant to Section 19.6 of the Illinois Oil and Gas Act (225 ILCS 725/19.6), the Department
does hereby assign and convey to the above named new or proposed new Permittee, all interest, title and ownership rights claimed
by the STATE OF ILLINOIS with respect to all surface and subsurface well production equipment associated with or that constitutes
the afore-described well(s), all other oil and gas production equipment in the immediate vicinity of and which pertains to said well(s),
all related oil and gas tank batteries and the oil fluids contained therein, and all other oil and gas related equipment contained on the
lease or unit. All equipment and hydrocarbons are hereby conveyed under clear title, subject to any prior perfected existing legal
or equitable claim pursuant to the Illinois Oil and Gas Act by Public Act, as amended by 90-260, effective July 31, 1997.
DEPARTMENT USE ONLY
EFFECTIVE THE DATE BELOW, THIS REQUEST TO TRANSFER THE ABOVE IDENTIFIED WELLS, FROM THE
PLUGGING AND RESTORATION PROGRAM, UNDER THE CONTROL OF THE DEPARTMENT OF NATURAL
RESOURCES, COMPLIES WITH ALL APPLICABLE REQUIREMENTS OF THE ILLINOIS OIL AND GAS ACT AND
RULES PROMULGATED BY THE DEPARTMENT AND IS APPROVED.
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
Printed by the State of Illinois
OG-26A –PRF Well Transfer Request (Rev. 3/2018)
Page 1 of 2
OG-26A
Office of Oil and Gas Resource Management
PLUGGING PROGRAM (PRF)
One Natural Resources Way
Springfield, IL 62702-1271
WELL TRANSFER REQUEST
(217) 782-7756
TRANSACTION # ______________
WELL INFORMATION
REFERENCE #: _______________________ PERMIT #: __________________________ DATE ISSUED: ________________________
WELL NAME: __________________________________________________________________________ WELL #: _____________
LOCATION: _______________________________________________________________________________________________________
SECTION: ______ TOWNSHIP: ________ (NORTH/SOUTH) RANGE: ________ (EAST/WEST) COUNTY: ____________________
LEASE / UNIT INFORMATION:
TOTAL NUMBER OF WELLS IN TRANSFER: __________________ CURRENT PERMITTEE #: _____________________
LEASE / UNIT NAME: __________________________________________
LEASE / UNIT LEGAL DESCRIPTION (ATTACH LEGAL DESCRIPTION OR MAP IF NECESSARY AND ATTACH WELL
LIST AS INSTRUCTED ON REVERSE SIDE.)
NEW PERMITTEE:
UNDER PENALTIES OF PERJURY, THE NEW PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE NEW PERMITTEE HAS THE RIGHT, PURSUANT TO VALID AND SUBSISTING OIL
AND GAS LEASES, DOCUMENTS, OR MEMORANDA OF PUBLIC RECORD, AND/OR STATUTE
OR REGULATION, TO OPERATE THE WELL(S) DESCRIBED HEREIN; AND
b) THAT THE NEW PERMITTEE HAS REVIEWED THIS TRANSFER REQUEST TOGETHER WITH
ANY ACCOMPANYING STATEMENTS AND DOCUMENTS AND STATES THAT TO THE BEST
OF THE NEW PERMITTEE’S KNOWLEDGE, THE REQUEST, STATEMENTS, AND DOCUMENTS
ARE TRUE AND CORRECT.
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _______________________________________________________________________________________________________
__________________________________________________________________
__________________________________________
PRINT NAME
TITLE
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
In conjunction with the final approval of the transfer request and the payment of the well salvage value of $____________(calculated
from the reverse side of this form) and pursuant to Section 19.6 of the Illinois Oil and Gas Act (225 ILCS 725/19.6), the Department
does hereby assign and convey to the above named new or proposed new Permittee, all interest, title and ownership rights claimed
by the STATE OF ILLINOIS with respect to all surface and subsurface well production equipment associated with or that constitutes
the afore-described well(s), all other oil and gas production equipment in the immediate vicinity of and which pertains to said well(s),
all related oil and gas tank batteries and the oil fluids contained therein, and all other oil and gas related equipment contained on the
lease or unit. All equipment and hydrocarbons are hereby conveyed under clear title, subject to any prior perfected existing legal
or equitable claim pursuant to the Illinois Oil and Gas Act by Public Act, as amended by 90-260, effective July 31, 1997.
DEPARTMENT USE ONLY
EFFECTIVE THE DATE BELOW, THIS REQUEST TO TRANSFER THE ABOVE IDENTIFIED WELLS, FROM THE
PLUGGING AND RESTORATION PROGRAM, UNDER THE CONTROL OF THE DEPARTMENT OF NATURAL
RESOURCES, COMPLIES WITH ALL APPLICABLE REQUIREMENTS OF THE ILLINOIS OIL AND GAS ACT AND
RULES PROMULGATED BY THE DEPARTMENT AND IS APPROVED.
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
Printed by the State of Illinois
OG-26A –PRF Well Transfer Request (Rev. 3/2018)
Page 1 of 2
OG-26A INSTRUCTIONS:
NEW PERMITTEE:
1)
COMPLETE AND SIGN OG-26A TRANSFER REQUEST FORM.
2)
PROVIDE REQUIRED BOND, IF APPLICABLE, IN ACCORDANCE WITH 62 Ill. Adm. Code 42 SUBPART O.
3)
IF THE NEW PERMITTEE IS A CORPORATION, PROVIDE EVIDENCE THAT THE CORPORATION, AND HAS NOT
PREVIOUSLY DONE SO, IS INCORPORATED OR AUTHORIZED TO DO BUSINESS IN THE STATE OF ILLINOIS,
AND AUTHORIZED UNDER ITS CHARTER TO ENGAGE IN THE PERMITTED ACTIVITY.
4)
IF THE NEW PERMITTEE IS AN INDIVIDUAL, PARTNERSHIP, OR OTHER UNINCORPORATED ENTITY THAT IS
NOT A RESIDENT OF ILLINOIS, AND HAS NOT PREVIOUSLY DONE SO, PROVIDE AN IRREVOCABLE CONSENT
TO BE SUED IN ILLINOIS.
5)
PROVIDE COPIES, IF REQUESTED BY THE DEPARTMENT, OF AN AFFIDAVIT OF NON-PRODUCTION, A NEW
RECORDED BASE LEASE, A COURT ORDER TERMINATING THE LEASE ON WHICH THE WELLS ARE
LOCATED, OR OTHER DOCUMENTS EVIDENCING THE RIGHT TO OPERATE THE WELLS INCLUDED IN THE
TRANSFER.
6)
PAY A SALVAGE VALUE FOR THE DOWN HOLE WELL EQUIPMENT (WELLS OLDER THAN 30 YEARS FROM
DATE DRILLED, SHALL BE DEEMED TO HAVE $0 SALVAGE VALUE) AND OTHER PRODUCTION EQUIPMENT
AS FOLLOWS:
A)
$50 PER WELL FOR WELLS LESS THAN 750 FEET IN DEPTH;
B)
$100 PER WELL FOR WELLS GREATER THAN 750 FEET AND LESS THAN 2000 FEET IN DEPTH;
C)
$250 PER WELL FOR WELLS 2000 FEET AND GREATER IN DEPTH; AND
D)
PAY A SALVAGE VALUE, APPROVED BY THE DEPARTMENT, FOR THE TANKS, PUMPING UNITS AND
OTHER RELATED SURFACE PRODUCTION EQUIPMENT, TO BE DETERMINED BY SUBMISSION OF
SALVAGE VALUE ESTIMATES FROM TWO (2) COMMERCIAL SALVAGE OIL AND GAS PRODUCTION
EQUIPMENT DEALERS.
7)
PAY FAIR MARKET PRICE (PER BARREL), ESTABLISHED AT THE TIME OF THE TRANSFER APPROVAL, FOR
ALL OIL FLUIDS (HYDROCARBONS) STORED ON THE LEASE OR UNIT BEING TRANSFERRED.
8)
SALVAGE PAYMENT SHALL BE BY CASHIERS CHECK.
9)
PAY REQUIRED TRANSFER FEE OF $50.00 PER WELL
DEPARTMENT USE ONLY:
CALCULATION OF SALVAGE VALUE:
WELLS AT $50 / WELL
=
WELLS AT $100 / WELL
=
WELLS AT $250 / WELL
=
HIGHEST SALVAGE VALUE ESTIMATE FOR ALL
=
SURFACE PRODUCTION EQUIPMENT
STORED HYDROCARBONS ON LEASE
BBLS. X $
/BBL =
TOTAL SALVAGE VALUE DUE
=
This state agency is requesting disclosure of information that is necessary to accomplish the statutory purposed as outlined in the Ill. Compiled Stat. Ch, 225, pars. 725
et.
seq. Failure to disclose this information will result in this form not being processed. This form has been approved by the Forms Management Center.
Printed by the State of Illinois
OG-26A –PRF Well Transfer Request (Rev. 3/2018)
Page 2 of 2

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