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

2. 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: 10-17-12(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 165:10-17-12] Question concerning this Form: For more information contact the Geology Department at (405) 521-6044.

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

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

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

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

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

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

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

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

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

12. 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

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

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

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

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

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

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

19. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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