Blanket Bond (Two or More Wells) - Form 3c

Blanket Bond (Two or More Wells) - Form 3.C Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5746 (02 to 2018)

Field: Surety Company Bond No.

Field: N.D.I.C Bond No.

the Bond Form and the Notary Page Shall Be Printed or Copied Front To Back Before Signing and Notarizing.

Please Read Instructions Before Filling Out Form.

Please Submit the Original.

Field: The principal of this bond is

Field: whose address is

Field: The surety of this bond is

Field: whose address is

Field: Surety is incorporated in the State of

and is authorized to do business in North Dakota.

In consideration of allowing the principal to drill or operate oil and/or gas wells, principal and surety are indebted to the State of North Dakota in the sum of $100,000, for which payment principal and surety binds ourselves and our legal representatives and successors, jointly and severally.

The condition of this obligation is that the principal desires to drill or operate two (2) or more oil and/or gas wells within the State of North Dakota and this bond is required by N.D.C.C.  38-08-04 and the North Dakota Industrial Commission s administrative rules. If the principal, in its operations, fully complies with N.D.C.C. Chapter 38 to 08 and the Industrial Commission s orders and administrative rules, together with all amendments to Chapter 38 to 08 and the administrative rules, then this obligation is void, otherwise it remains in full force and effect.

The bond shall remain in full force and effect until such time as the principal has fully complied with all requirements set forth by the Commission and the Commission authorizes the release of the bond, or until other financial assurances are in place and approved by the Commission. If the principal does not fully satisfy the Commission s requirements for release of the bond, then the surety shall satisfy the remaining requirements or forfeit the face value of the bond to the Commission. The bond shall not be terminated, amended, or transferred without prior written approval of the Commission.

North Dakota law governs this bond.

Instructions for signatures:

If you are a corporation, use your full corporate name and have a corporate officer sign. If you are a partnership, so state and have at least one general partner sign. If you are an individual doing business under a business name, state your name and your business name and after your signature state that you are the sole owner. Any other person signing on behalf of the principal or surety must attach a power of attorney.

Field: Name of Principal

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Signature

Field: Printed Name

Field: Title

Field: Date

(See Other Side for Notary)

Field: Name of Surety

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Signature

Field: Printed Name

Field: Title

Field: Date

(See Other Side for Notary)

Acknowledgement of Principal

Field: State of

Field: County of

Field: Notary Seal

On ____________________ _, known to me to be the person described in and who executed the foregoing instrument, personally appeared before me and acknowledged that (s)he executed the same as a free act and deed.

Field: Notary Public

Field: My Commission Expires

Acknowledgement of Surety

Field: State of

Field: County of

Field: Notary Seal

On ____________________ _, known to me to be the person described in and who executed the foregoing instrument, personally appeared before me and acknowledged that (s)he executed the same as a free act and deed.

Field: Notary Public

Field: My Commission Expires

Instructions

1. Please refer to Section 43-02-03-15 of the North Dakota Administrative Code regarding bonds.

2. Name of principal shall be the name of the operator and shall be the same as reported on the Organization Report - Form 2 (S.F.N 5748).

3. The bond form and the notary page shall be printed or copied front to back before signing and notarizing.

4. The original of this report shall be filed with the Department of Mineral Resources, Oil and Gas Division, 600 East Boulevard, Dept. 474, Bismarck, N.D 58505 to 0614.