Form PR4312 "Application to Amend Oil and Gas Lease" - Michigan

What Is Form PR4312?

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

Form Details:

  • Released on February 11, 2020;
  • The latest edition provided by the Michigan 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 PR4312 by clicking the link below or browse more documents and templates provided by the Michigan Department of Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download Form PR4312 "Application to Amend Oil and Gas Lease" - Michigan

Download PDF

Fill PDF online

Rate (4.6 / 5) 12 votes
DNR Cashier’s Use Only
Michigan Department of Natural Resources – Minerals Management Section
A
A
O
G
L
PPLICATION TO
MEND
IL AND
AS
EASE
This information is required by authority of Part 5, Section 502, Act 451 of 1994, as amended.
Check the box for the type of lease amendment you are applying for:
Dept
Approp
Fund
Unit
Dept Rev Function
Parcel Reclassification
751
45100
1284
7900
9162
MM9070
DNR Use Only
Classification Review
(nondevelopment lease not field reviewed for auction)
Parcel ID
Class, Stips, Approved Par ids
Change in Restrictions
Variance in Lease Terms
(1320’; road or pipeline across nondevelopment lease)
The application fee for reclassification, variance, and change of restrictions is $2,000 per lease. The application fee for a classification
review (to determine the classification of a nondevelopment lease that had not been field reviewed for auction) is $200 per lease. If the
classification review determines the lease should be amended to Development or Development with Restrictions, Lessee will be invoiced
$800 to amend the lease. A check payable to “State of Michigan” must accompany this completed application.
If the reclassification or classification amendment is approved, the lease bonus will be recalculated to reflect the bonus paid on leases with
similar classification, in the same vicinity, at the same state lease sale. Lessee will be invoiced for the amount of bonus due.
If the Michigan Department of Natural Resources (DNR) is not the surface owner of the land involved, Applicant must also submit a copy of
the voluntary agreement or stipulated settlement, pursuant to lease terms F2 or G2, as applicable, if the agreement is available at the time
of application.
If Applicant is not the Lessee, Applicant must provide Lessee’s written consent to this application. Please note, we cannot process the
application until we have received Lessee’s written consent.
Please print. Attach additional sheets if needed.
Name of Lessee
Lease Number
Address
Surface Owner’s Name (if not State of Michigan)
City, State, ZIP
Address
Lessee Contact Name
Contact Telephone
City, State, ZIP
Company and Contact Applying on Behalf of
Address, City. State, ZIP
Contact Telephone
Lessee, if applicable
For Reclassification/Classification Review/Change in Restrictions Applications Only: Legal description of parcel(s) to be reclassified/reviewed for
classification/change in restrictions. Include county and township. If application is not for all parcels under lease, check box
I certify all the information contained herein and all attachments are true and correct to the best of my knowledge.
Signature of Applicant
Date
Make check or money order payable to “State of Michigan” and mail with the completed application; survey (if
applicable, see page 2); and voluntary agreement (if applicable) to:
CASHIER’S OFFICE
MICHIGAN DEPARTMENT OF NATURAL RESOURCES
PO BOX 30451
LANSING MI 48909
1
PR4312 (Rev. 02/11/2020)
DNR Cashier’s Use Only
Michigan Department of Natural Resources – Minerals Management Section
A
A
O
G
L
PPLICATION TO
MEND
IL AND
AS
EASE
This information is required by authority of Part 5, Section 502, Act 451 of 1994, as amended.
Check the box for the type of lease amendment you are applying for:
Dept
Approp
Fund
Unit
Dept Rev Function
Parcel Reclassification
751
45100
1284
7900
9162
MM9070
DNR Use Only
Classification Review
(nondevelopment lease not field reviewed for auction)
Parcel ID
Class, Stips, Approved Par ids
Change in Restrictions
Variance in Lease Terms
(1320’; road or pipeline across nondevelopment lease)
The application fee for reclassification, variance, and change of restrictions is $2,000 per lease. The application fee for a classification
review (to determine the classification of a nondevelopment lease that had not been field reviewed for auction) is $200 per lease. If the
classification review determines the lease should be amended to Development or Development with Restrictions, Lessee will be invoiced
$800 to amend the lease. A check payable to “State of Michigan” must accompany this completed application.
If the reclassification or classification amendment is approved, the lease bonus will be recalculated to reflect the bonus paid on leases with
similar classification, in the same vicinity, at the same state lease sale. Lessee will be invoiced for the amount of bonus due.
If the Michigan Department of Natural Resources (DNR) is not the surface owner of the land involved, Applicant must also submit a copy of
the voluntary agreement or stipulated settlement, pursuant to lease terms F2 or G2, as applicable, if the agreement is available at the time
of application.
If Applicant is not the Lessee, Applicant must provide Lessee’s written consent to this application. Please note, we cannot process the
application until we have received Lessee’s written consent.
Please print. Attach additional sheets if needed.
Name of Lessee
Lease Number
Address
Surface Owner’s Name (if not State of Michigan)
City, State, ZIP
Address
Lessee Contact Name
Contact Telephone
City, State, ZIP
Company and Contact Applying on Behalf of
Address, City. State, ZIP
Contact Telephone
Lessee, if applicable
For Reclassification/Classification Review/Change in Restrictions Applications Only: Legal description of parcel(s) to be reclassified/reviewed for
classification/change in restrictions. Include county and township. If application is not for all parcels under lease, check box
I certify all the information contained herein and all attachments are true and correct to the best of my knowledge.
Signature of Applicant
Date
Make check or money order payable to “State of Michigan” and mail with the completed application; survey (if
applicable, see page 2); and voluntary agreement (if applicable) to:
CASHIER’S OFFICE
MICHIGAN DEPARTMENT OF NATURAL RESOURCES
PO BOX 30451
LANSING MI 48909
1
PR4312 (Rev. 02/11/2020)
ADDITIONAL INFORMATION REQUIRED FOR RECLASSIFICATIONS, VARIANCES,
AND CHANGE OF RESTRICTIONS ONLY
In addition to the application, voluntary agreement (if applicable), and fee, include the following information:
A detailed survey of the area, clearly depicting the proposed well site, proposed road access, and/or proposed
pipeline location, (if applicable), and all surface features. Identify the direction and distance to lakes and streams
that are within 1,320 feet of the surface location of the well. Also identify the boundaries of the drilling unit.
Answer the following questions, as applicable:
Proposed Well Surface Location (footages per survey, not approximate)
What alternate locations were considered?
Why does the well need to be drilled from this location?
How will the proposed well location protect surface resources?
For Change in Restrictions Applications Only: What are the current lease restrictions you are requesting to change? What specific changes are you
requesting?
For 1320’ Variance Requests Only: What bodies of water are you requesting exception to? How will the non-conforming well location result in less
environmental impact than a well location greater than 1,320 feet from the surface waters?
For Reclassification/Change in Restrictions Applications Only: Briefly describe the reason for the request (i.e., change in nature of the land, species
relocation, etc.).
2
PR4312 (Rev. 02/11/2020)
Page of 2