Form MO780-2227 "Oil and Gas Notice to Cancel Well Permit - Geological Survey Program" - Missouri

What Is Form MO780-2227?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-2227 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2227 "Oil and Gas Notice to Cancel Well Permit - Geological Survey Program" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS NOTICE TO CANCEL WELL PERMIT
WELL PERMIT INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
OPERATOR LICENSE NUMBER
WELLS IN MISSOURI
COUNTY
PRODUCTION UNIT (LEASE OR SURFACE UNIT NAME)
API NUMBER
WELL NUMBER
PERMIT NUMBER
STATE REASON FOR WELL PERMIT CANCELLATION
CERTIFICATION
I, the undersigned, certify that:
I am authorized to act as an agent for this company.
The well was never drilled and requires no remedial or plugging actions, as required by the Missouri Code of State Regulations Oil and Gas
Rules 10 CSR 50.
The information on this form has been reviewed by me and is true, correct and complete to the best of my knowledge.
TITLE
COMPANY
PRINT NAME
PRIMARY TELEPHONE NUMBER WITH AREA CODE
EMAIL ADDRESS
SIGNATURE
DATE
Form 780-2227 (03-18) SEND COMPLETED FORM TO: DEPARTMENT OF NATURAL RESOURCES, MISSOURI GEOLOGICAL SURVEY, GEOLOGIC RESOURCES SECTION,
PO BOX 250, ROLLA, MO 65402-0250 PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
oilandgas@dnr.mo.gov
MISSOURI DEPARTMENT OF NATURAL RESOURCES
GEOLOGICAL SURVEY PROGRAM
OIL AND GAS NOTICE TO CANCEL WELL PERMIT
WELL PERMIT INFORMATION
NAME OF COMPANY, ORGANIZATION, OR INDIVIDUAL THAT DRILLS, MAINTAINS, OPERATES, OR CONTROLS OIL AND GAS
OPERATOR LICENSE NUMBER
WELLS IN MISSOURI
COUNTY
PRODUCTION UNIT (LEASE OR SURFACE UNIT NAME)
API NUMBER
WELL NUMBER
PERMIT NUMBER
STATE REASON FOR WELL PERMIT CANCELLATION
CERTIFICATION
I, the undersigned, certify that:
I am authorized to act as an agent for this company.
The well was never drilled and requires no remedial or plugging actions, as required by the Missouri Code of State Regulations Oil and Gas
Rules 10 CSR 50.
The information on this form has been reviewed by me and is true, correct and complete to the best of my knowledge.
TITLE
COMPANY
PRINT NAME
PRIMARY TELEPHONE NUMBER WITH AREA CODE
EMAIL ADDRESS
SIGNATURE
DATE
Form 780-2227 (03-18) SEND COMPLETED FORM TO: DEPARTMENT OF NATURAL RESOURCES, MISSOURI GEOLOGICAL SURVEY, GEOLOGIC RESOURCES SECTION,
PO BOX 250, ROLLA, MO 65402-0250 PHONE: 573-368-2100 FAX: 573-368-2111 EMAIL:
oilandgas@dnr.mo.gov