DNR OOGRM Form OG-26CP Notification of Well Transfer - Illinois

DNR OOGRM Form OG-26CP or the "Notification Of Well Transfer" is a form issued by the Illinois Department of Natural Resources - Office of Oil and Gas Resource Management.

The form was last revised in March 1, 2018 and is available for digital filing. Download an up-to-date DNR OOGRM Form OG-26CP in PDF-format down below or look it up on the Illinois Department of Natural Resources - Office of Oil and Gas Resource Management Forms website.

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OG-26CP
NOTIFICATION OF
Office of Oil and Gas Resource Management
One Natural Resources Way
WELL TRANSFER
Springfield, IL 62702-1271
(217) 782-7756
THE SELLER SHOULD COMPLETE THIS FORM, SUBMIT THE ORIGINAL TO THE
DEPARTMENT AND PROVIDE A COPY TO THE PURCHASER.
☐ 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
CURRENT PERMITTEE:
UNDER PENALTIES OF PERJURY, THE CURRENT PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE CURRENT PERMITTEE HAS TRANSFERRED 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 TO THE NEW PERMITTEE LISTED BELOW; AND
b) THAT THE CURRENT PERMITTEE HAS REVIEWED THIS TRANSFER REQUEST
TOGETHER WITH ANY ACCOMPANYING STATEMENTS AND DOCUMENTS AND STATES
THAT TO THE BEST OF THE CURRENT PERMITTEE’S KNOWLEDGE, THE REQUEST,
STATEMENTS, AND DOCUMENTS ARE TRUE AND CORRECT.
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _______________________________________________________________________________________________________
__________________________________________________________________
__________________________________________
PRINT NAME
TITLE
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
NEW PERMITTEE:
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _________________________________________________________________________________________________
DATE OF ASSIGNMENT: ___________________________
Printed by the State of Illinois
OG-26CP – Seller Transfer (Rev. 3/2018)
Page 1 of 2
OG-26CP
NOTIFICATION OF
Office of Oil and Gas Resource Management
One Natural Resources Way
WELL TRANSFER
Springfield, IL 62702-1271
(217) 782-7756
THE SELLER SHOULD COMPLETE THIS FORM, SUBMIT THE ORIGINAL TO THE
DEPARTMENT AND PROVIDE A COPY TO THE PURCHASER.
☐ 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
CURRENT PERMITTEE:
UNDER PENALTIES OF PERJURY, THE CURRENT PERMITTEE LISTED BELOW CERTIFIES AS FOLLOWS:
a) THAT THE CURRENT PERMITTEE HAS TRANSFERRED 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 TO THE NEW PERMITTEE LISTED BELOW; AND
b) THAT THE CURRENT PERMITTEE HAS REVIEWED THIS TRANSFER REQUEST
TOGETHER WITH ANY ACCOMPANYING STATEMENTS AND DOCUMENTS AND STATES
THAT TO THE BEST OF THE CURRENT PERMITTEE’S KNOWLEDGE, THE REQUEST,
STATEMENTS, AND DOCUMENTS ARE TRUE AND CORRECT.
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _______________________________________________________________________________________________________
__________________________________________________________________
__________________________________________
PRINT NAME
TITLE
__________________________________________________________________
__________________________________________
SIGNATURE
DATE
NEW PERMITTEE:
NAME: ____________________________________________________________________ PERMITTEE #: _______________________
ADDRESS: _________________________________________________________________________________________________
DATE OF ASSIGNMENT: ___________________________
Printed by the State of Illinois
OG-26CP – Seller Transfer (Rev. 3/2018)
Page 1 of 2
OG-26CP INSTRUCTIONS:
CURRENT PERMITTEE:
1.
COMPLETE AND SIGN THIS FORM. FORWARD IT TO THE DEPARTMENT AND PROVIDE A COPY TO THE
NEW PERMITTEE. USE (1) FORM FOR EACH INDIVIDUAL WELL TRANSFER REQUEST OR FOR EACH
LEASE FOR MULTIPLE WELL TRANSFER REQUESTS.
2.
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.
3.
PROVIDE A LIST OF ALL WELLS KNOWN TO THE CURRENT PERMITTEE FOR WHICH NO PERMIT HAS
PREVIOUSLY BEEN ISSUED, WHICH ARE LOCATED ON THE TRANSFERRED LEASE OR UNIT.
4.
PROVIDE COPIES, IF REQUESTED BY THE DEPARTMENT, OF THE LEASE ASSIGNMENT, VOLUNTARY
RELEASE, COURT ORDER, OR OTHER DOCUMENTS EVIDENCING THE ASSIGNMENT, TRANSFER OR
SALE OF THE RIGHT TO DRILL AND OPERATE THE WELL(S) ON THE LANDS IN QUESTION.
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-26CP – Seller Transfer (Rev. 3/2018)
Page 2 of 2
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