Form OG-26NP Notification of Acceptance of Well Transfer - Illinois

Form OG-26NP is a Illinois Department of Natural Resources form also known as the "Notification Of Acceptance Of Well Transfer". The latest edition of the form was released in March 1, 2018 and is available for digital filing.

Download a PDF version of the Form OG-26NP down below or find it on Illinois Department of Natural Resources Forms website.

ADVERTISEMENT
OG-26NP
NOTIFICATION OF
Office of Oil and Gas Resource Management
One Natural Resources Way
ACCEPTANCE OF
Springfield, IL 62702-1271
WELL TRANSFER
(217) 782-7756
THE PURCHASER SHOULD COMPLETE THIS FORM, SUBMIT THE ORIGINAL TO
THE DEPARTMENT AND PROVIDE A COPY TO THE SELLER.
☐ INDIVIDUAL WELL
☐ LEASE/UNIT
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: __________ LEASE / UNIT NAME: __________________________________________
LEASE / UNIT LEGAL DESCRIPTION (ATTACH LEGAL DESCRIPTION OR MAP IF NECESSARY AND ATTACH WELL LIST AS
INSTRUCTED ON REVERSE SIDE.)
FACILITY INFORMATION:
TANK BATTERY REGISTRATION # _________________________ SECTION: _______ TOWNSHIP: ________ RANGE: _______
CONCRETE STORAGE STRUCTURE PERMIT #: ______________ SECTION: ________ TOWNSHIP: ________ RANGE: _______
ATTACH LIST IF MORE THAN 1 FACILITY IS INCLUDED IN THE TRANSFER
NEW PERMITTEE:
UNDER PENALTIES OF PERJURY, THE NEW PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE NEW PERMITTEE HAS ACQUIRED 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 FROM THE CURRENT PERMITTEE LISTED BELOW; 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
CURRENT PERMITTEE:
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _________________________________________________________________________________________________
DATE OF ASSIGNMENT: ___________________________
Printed by the State of Illinois
OG-26NP –Notification of Acceptance of Well Transfer (Rev. 3/2018)
Page 1 of 2
OG-26NP
NOTIFICATION OF
Office of Oil and Gas Resource Management
One Natural Resources Way
ACCEPTANCE OF
Springfield, IL 62702-1271
WELL TRANSFER
(217) 782-7756
THE PURCHASER SHOULD COMPLETE THIS FORM, SUBMIT THE ORIGINAL TO
THE DEPARTMENT AND PROVIDE A COPY TO THE SELLER.
☐ INDIVIDUAL WELL
☐ LEASE/UNIT
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: __________ LEASE / UNIT NAME: __________________________________________
LEASE / UNIT LEGAL DESCRIPTION (ATTACH LEGAL DESCRIPTION OR MAP IF NECESSARY AND ATTACH WELL LIST AS
INSTRUCTED ON REVERSE SIDE.)
FACILITY INFORMATION:
TANK BATTERY REGISTRATION # _________________________ SECTION: _______ TOWNSHIP: ________ RANGE: _______
CONCRETE STORAGE STRUCTURE PERMIT #: ______________ SECTION: ________ TOWNSHIP: ________ RANGE: _______
ATTACH LIST IF MORE THAN 1 FACILITY IS INCLUDED IN THE TRANSFER
NEW PERMITTEE:
UNDER PENALTIES OF PERJURY, THE NEW PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE NEW PERMITTEE HAS ACQUIRED 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 FROM THE CURRENT PERMITTEE LISTED BELOW; 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
CURRENT PERMITTEE:
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _________________________________________________________________________________________________
DATE OF ASSIGNMENT: ___________________________
Printed by the State of Illinois
OG-26NP –Notification of Acceptance of Well Transfer (Rev. 3/2018)
Page 1 of 2
OG-26NP INSTRUCTIONS:
NEW PERMITTEE:
1.
THE NEW PERMITTEE CONFIRMS RECEIPT OF THE WELLS INCLUDED IN THE TRANSFER BY COMPLETING
AND SIGNING THE OG-26NP FORM. THE NEW PERMITTEE SHALL NOT OPERATE THE WELLS UNTIL THE
TRANSFER IS APPROVED BY THE DEPARTMENT.
2.
COMPLETE AND SIGN THIS FORM. FORWARD IT TO THE DEPARTMENT AND A COPY TO THE SELLER
(CURRENT PERMITTEE). USE (1) FORM FOR EACH INDIVIDUAL WELL TRANSFER REQUEST OR FOR EACH
LEASE FOR MULTIPLE WELL TRANSFER REQUESTS.
3.
IF MORE THAN ONE WELL, PROVIDE A LIST OF ALL WELLS TO BE INCLUDED IN THE TRANSFER,
SHOWING WELL NAME, LOCATION, PERMIT NUMBER AND REFERENCE NUMBER IF AVAILABLE.
4.
PROVIDE A LIST OF ALL WELLS KNOWN TO THE SELLER (CURRENT PERMITTEE) FOR WHICH NO PERMIT
HAS PREVIOUSLY BEEN ISSUED, WHICH ARE LOCATED ON THE TRANSFERRED LEASE OR UNIT.
5.
PROVIDE COPIES, IF REQUESTED BY THE DEPARTMENT, OF THE LEASE ASSIGNMENT OR OTHER
DOCUMENTS EVIDENCING THE ASSIGNMENT, TRANSFER OR SALE TO THE NEW PERMITTEE.
6.
PROVIDE THE REQUIRED BOND, IF APPLICABLE, IN ACCORDANCE WITH 62 Ill. Adm. Code 42 SUBPART O.
7.
IF THE NEW PERMITTEE IS A CORPORATION, PROVIDE EVIDENCE THAT THE CORPORATION IS
INCORPORATED OR AUTHORIZED TO DO BUSINESS IN THE STATE OF ILLINOIS, AND AUTHORIZED
UNDER ITS CHARTER TO ENGAGE IN THE PERMITTED ACTIVITY.
8.
IF THE NEW PERMITTEE IS AN INDIVIDUAL, PARTNERSHIP, OR OTHER UNINCORPORATED ENTITY THAT
IS NOT A RESIDENT OF ILLINOIS, PROVIDE AN IRREVOCABLE CONSENT TO BE SUED IN ILLINOIS.
9.
PAY THE REQUIRED TRANSFER FEE WHICH WILL BE BILLED TO NEW PERMITTEE AFTER DEPARTMENT
REVIEW AND APPROVAL OF TRANSFER. THE FEE IS $50.00 PER WELL.
10.
ONCE ISSUED, IF THE NEW PERMITTEE HAS AN FEIN NUMBER, IT WILL BE REQUIRED TO SUBMIT THE
NUMBER TO THE DEPARMENT.
This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose 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-26NP –Notification of Acceptance of Well Transfer (Rev. 3/2018)
Page 2 of 2
ADVERTISEMENT
Page of 2