FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule)

This presentation will assist you in the completion of the Form 1021A. The hardship well application (limited deviation rule). Date of Last Revision: 2001 Rule Requirement: (h) Explanation of Form: The applicant shall file Form 1021A and the necessary attachments with the Technical Services Department for review prior to any hearing for deviation from the priority gas rules. In addition, a formal application for hearing must be filed with the Court Clerk's Office of the Commission. [Reference 165: ] Question concerning this Form: For more information contact the Geology Department at (405)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OPERATOR’S NAME

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OTC/OCC OPERATOR NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) MAILING ADDRESS, PHONE NUMBER, CITY, STATE, AND ZIP CODE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PIPLINE COMPANY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OTC/OCC NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PHONE NUMBER OF PIPELINE COMPANY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LEASE NAME AND NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) API NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OTC PRODUCTION UNIT NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LEGAL LOCATION – include quarter section calls, section, township, range and the county where the well is located

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) TYPE OF COMPLETION

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) ORDER NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) DATE OF ORDER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) TOTAL DEPTH

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) COMPLETION DATE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) DATE OF 1 ST SALES

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PRODUCING ZONE(S) ALL OF THE DATA CONCERNING THE LEASE MATCH WITH THE INFORMATION PROVIDED ON THE FORM 1002A

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PERFORATIONS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) SPECIAL ALLOCATED POOL

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) FIELD NAME

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) POOL NUMBER

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) CLASSIFICATION ON FORM 1002A

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - DATE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST – Gas (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST – Oil (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST – Water (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST – GOR (Gas/Oil Ratio)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - SITP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - FTP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - BHP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - Actual

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) INITIAL TEST - Calculated

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - Date

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST – Gas (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST – Oil (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST – Water (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST – GOR (Gas/Oil Ratio)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - SITP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - FTP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - BHP

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - Actual

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) LATEST TEST - Calculated

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PRODUCTION HISTORY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) CUMULATIVE PRODUCTION AS OF (Give Date)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) GAS (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OIL (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) REMAINING RESERVES AS OF (give Date)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) GAS (in MCF)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OIL (in Bbls)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) METHOD OF CALCULATING RESERVES (attach a copy of calculations or curve)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) AVERAGE PIPELINE PRESSURE

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) IS COMPRESSION NECESSARY

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) ARE THE WELLS IN THE AREA BEING PRODUCED RATABLY (IF NOT, EXPLAIN)

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) PRODUCTION PROBLEMS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) WAS THE PIPELINE AND OFFSET OPERATORS NOTIFIED OF HEARING

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) NET REV. INT. TO WORKING INTEREST

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) NET PRICE RECEIVED PER MCF

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) NET PRICE RECEIVED PER Bbls

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) TOTAL GROSS INCOME FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) AVERAGE GROSS INCOME PER MONTH

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) OPERATIONAL COSTS FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) NET MONTHLY AVERAGE INCOME FOR THE LAST 3 MONTHS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) REMARKS

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) BE SURE AND INCLUDE ALL OF THE FOLLOWING

FORM 1021A – HARDSHIP WELL APPLICATION (Limited Deviation Rule) FOR OCC USE ONLY – Do not write below this line