Notice Of Transfer Of Treating Plant Facility - Form 15p

Notice of Transfer of Treating Plant Facility - Form 15.P Department of Mineral Resources Oil and Gas Division 600 East Boulevard Dept 474 Bismark, N.D 58505 to 0614 S.F.N 5762 (01 to 2016)

for State Use Only

Field: ndic Bond Number

Please Read Instructions Before Filling Out Form. Please Submit the Original and Six Copies.

This Notice Shall Be Filed At Least Thirty Days Before the Closing Date of Transfer.

Transferring Operator

Checkbox option: Reset

Checkbox option: View

Checkbox option: Print

Field: Name of Operator Representative

Field: Operator Transferring Treating Plant Facility

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

I, the above named representative, acknowledge the transfer of the treating plant facility named below for the purpose of ownership and/or operation to the company named below.

Field: Signature

Field: Title (Must be an officer or power of attorney must be attached)

Field: Date

Field: Facility File No.

Field: Requested Official Facility Name

Field: Location (Qtr-Qtr, S-T-R)

Field: Assignment Date

Receiving Operator

Field: Name of Operator Representative

Field: Operator Receiving Treating Plant Facility

Field: Telephone Number

Field: Address

Field: City

Field: State

Field: Zip Code

I, the above named representative, have read the foregoing statement and accept such transfer, also the responsibility of ownership and/or operation of said facility, under the said company bond, said bond being tendered to or on file with the Industrial Commission of North Dakota.

Field: Signature

Field: Title (Must be an officer or power of attorney must be attached)

Field: Date

Surety Company

Field: Surety

Field: Telephone Number

Field: Amount of Bond $

Field: Address

Field: City

Field: State

Field: Zip Code

Field: Bond Number

The above named Surety agrees that such bond shall extend to compliance with Chapter 38 to 08 of North Dakota Century Code and amendments and the rules and regulations of the Industrial Commission of North Dakota prescribed to govern the production of oil and gas on government and private lands within the State of North Dakota, in relation to the above stated transfer; it being further agreed and understood that the bond sum or amount is not to be considered increased because of such extension.

Field: Signature

Field: Title (Must be an officer or power of attorney must be attached)

Field: Date

for State Use Only

Field: Printed Name

Field: Date Approved

Field: By

Field: Title