Form 19 "Release Agreement" - Montana

What Is Form 19?

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

Form Details:

  • Released on October 1, 2009;
  • The latest edition provided by the Montana Department of Natural Resources and Conservation;
  • 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 19 by clicking the link below or browse more documents and templates provided by the Montana Department of Natural Resources and Conservation.

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Download Form 19 "Release Agreement" - Montana

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FORM NO. 19 R 10/09
ARM: 36.22.307
36.22.502
36.22.1305
SUBMIT IN QUADRUPLICATE TO
MONTANA BOARD OF OIL AND GAS CONSERVATION
2535 ST JOHNS AVENUE
BILLINGS, MONTANA 59102
RELEASE AGREEMENT
KNOW ALL MEN BY THESE PRESENTS, that I, _________________________________________________
______________________________________________of the County of ______________________________________
in the State of Montana, am the owner of the hereinafter described land upon which a well for oil, gas, or seismic explor-
ation was drilled, to-wit:
Operator _________________________________________________________________________________________
Address __________________________________________________________________________________________
Lease Name ________________________________________________Well Number __________________________
API # 25-________- ______________ Section _______ Township _____________ Range _____________ and
Located ________________ feet from (
) line and _________________ feet from (
) line of said section.
(N or S)
(E or W)
That, in accordance with Board Rules 36.22.1305 or 36.22.502(5),
I do hereby notify the Board of Oil and Gas Conservation of the State of Montana of my desire to utilize said well
as a fresh water well; and, that if such utilization is approved, I do hereby release and discharge the operator hereinabove
named from any further work or responsibility in relation to the plugging of said well.
Water Use:
Domestic ______
Stock _____
Irrigation _____
Municipal ______
Industrial _____
Drainage _____
Other
______
(check any applicable uses)
Producing Depth ___________________________
Producing Formation _________________________
Yield of Well ______________________________
Annual Withdrawal __________________________
WITNESS my hand this ___________________ day of _____________________________ , _______________
___________________________________________________
Landowner Signature
__________________________________________________________________________________________________
Landowner Address
City
State
Zip Code
Telephone Number
IN THE PRESENCE OF:
____________________________________ Address ______________________________________________________
____________________________________ Address ______________________________________________________
APPROVED BY
MONTANA BOARD OF OIL AND GAS CONSERVATION
______________________________________________________
Name / Title
______________________________________________________
Date
(SEE REVERSE SIDE)
FORM NO. 19 R 10/09
ARM: 36.22.307
36.22.502
36.22.1305
SUBMIT IN QUADRUPLICATE TO
MONTANA BOARD OF OIL AND GAS CONSERVATION
2535 ST JOHNS AVENUE
BILLINGS, MONTANA 59102
RELEASE AGREEMENT
KNOW ALL MEN BY THESE PRESENTS, that I, _________________________________________________
______________________________________________of the County of ______________________________________
in the State of Montana, am the owner of the hereinafter described land upon which a well for oil, gas, or seismic explor-
ation was drilled, to-wit:
Operator _________________________________________________________________________________________
Address __________________________________________________________________________________________
Lease Name ________________________________________________Well Number __________________________
API # 25-________- ______________ Section _______ Township _____________ Range _____________ and
Located ________________ feet from (
) line and _________________ feet from (
) line of said section.
(N or S)
(E or W)
That, in accordance with Board Rules 36.22.1305 or 36.22.502(5),
I do hereby notify the Board of Oil and Gas Conservation of the State of Montana of my desire to utilize said well
as a fresh water well; and, that if such utilization is approved, I do hereby release and discharge the operator hereinabove
named from any further work or responsibility in relation to the plugging of said well.
Water Use:
Domestic ______
Stock _____
Irrigation _____
Municipal ______
Industrial _____
Drainage _____
Other
______
(check any applicable uses)
Producing Depth ___________________________
Producing Formation _________________________
Yield of Well ______________________________
Annual Withdrawal __________________________
WITNESS my hand this ___________________ day of _____________________________ , _______________
___________________________________________________
Landowner Signature
__________________________________________________________________________________________________
Landowner Address
City
State
Zip Code
Telephone Number
IN THE PRESENCE OF:
____________________________________ Address ______________________________________________________
____________________________________ Address ______________________________________________________
APPROVED BY
MONTANA BOARD OF OIL AND GAS CONSERVATION
______________________________________________________
Name / Title
______________________________________________________
Date
(SEE REVERSE SIDE)
Board Rule 36.22.502 (Plugging and abandonment):
(5) A seismic shot hole may be left unplugged at the request of the surface owner for conversion
to a fresh water well provided the surface owner executes a release on Form No. 19 relieving the
party otherwise responsible for the plugging and abandonment of the hole from any liability for
damages that may thereafter result from the hole remaining unplugged. This release will cite the date,
location, surface elevation, depth to aquifer, and any action taken. This information shall be furnished
by the geophysical operator. The surface owner must also notify and file within 30 days appropriate
forms with the water rights bureau of the department of natural resources and conservation. The
surface owner must also apply for a permit from the board of water well contractors, and explain in
detail the procedures to be used in constructing the well. This is to insure that the shot hole is
properly constructed, cased and developed into a water well, according to the minimum construction
standards for water wells, as adopted by the board of water well contractors.
Board Rule 36.22.1305 (Exception for fresh water wells):
(1) When the well to be plugged, as required by ARM 36.22.1303, may safely be used as a
freshwater well and such utilization is desired by the landowner, the well need not be filled above the
required sealing plug set below freshwater; provided, that written notification of such utilization and a
release by use of Form No. 19 is secured from the landowner and filed with the board.
(2) Approval by the petroleum engineer or his authorized agent of the work done shall relieve the
operator of further responsibility.
Application for water rights:
Complete applicable Form No. 600 or 602 following well completion and submit with electric log (if
run) showing the pertinent sand, to the Water Rights Bureau, P.O. Box 201601, Helena, Montana
59620-1601.
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