1. FORM 1021 – HARDSHIP WELL APPLICATION

2. This presentation will assist you in the completion of the Form 1021. The hardship well application. Date of Last Revision: 2001 Rule Requirement: 10-17-12(h) Explanation of Form: The applicant shall file Form 1021 and the necessary attachments with the Technical Services Department for review prior to any hearing for priority one hardship classification. 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 1021 – HARDSHIP WELL APPLICATION OPERATOR NAME

4. FORM 1021 – HARDSHIP WELL APPLICATION OTC/OCC OPERATOR NUMBER

5. FORM 1021 – HARDSHIP WELL APPLICATION MAILING ADDRESS, PHONE NUMBER, CITY, STATE, AND ZIP CODE

6. FORM 1021 – HARDSHIP WELL APPLICATION PIPELINE COMPANY

7. FORM 1021 – HARDSHIP WELL APPLICATION PHONE NUMBER OF PIPELINE COMPANY

8. FORM 1021 – HARDSHIP WELL APPLICATION OTC/OCC NUMBER

9. FORM 1021 – HARDSHIP WELL APPLICATION LEASE NAME AND NUMBER

10. FORM 1021 – HARDSHIP WELL APPLICATION LOCATION WITH THE SECTION: quarter section calls, section, township and range and the county location

11. FORM 1021 – HARDSHIP WELL APPLICATION OTC PRODUCTION UNIT NUMBER

12. FORM 1021 – HARDSHIP WELL APPLICATION API NUMBER

13. FORM 1021 – HARDSHIP WELL APPLICATION WELL COMPLETION DATE

14. FORM 1021 – HARDSHIP WELL APPLICATION TOTAL DEPTH OF THE WELL

15. FORM 1021 – HARDSHIP WELL APPLICATION PRODUCING ZONE(S)

16. FORM 1021 – HARDSHIP WELL APPLICATION PERFORATIONS

17. FORM 1021 – HARDSHIP WELL APPLICATION COMMINGLED OR DUALLY COMPLETED

18. FORM 1021 – HARDSHIP WELL APPLICATION ORDER NUMBER AND DATE OF THE ORDER IF ALL OF THE INFORMATION ABOVE THIS POINT HAS NOT BEEN COMPLETED DO NOT SUBMIT THIS REPORT AS IT WILL NOT BE PROCESSED

19. FORM 1021 – HARDSHIP WELL APPLICATION LAST TEST DATE

20. FORM 1021 – HARDSHIP WELL APPLICATION GAS (IN MCF/D)

21. FORM 1021 – HARDSHIP WELL APPLICATION OIL (IN BBLS/D)

22. FORM 1021 – HARDSHIP WELL APPLICATION WATER (IN BBLS/D)

23. FORM 1021 – HARDSHIP WELL APPLICATION LAST MONTH – NUMBER OF DAYS ONLINE THIS HISTORICAL TEST DATA IS VERY IMPORTANT AND MUST BE SUBMITTED

24. FORM 1021 – HARDSHIP WELL APPLICATION GAS PRODUCED

25. FORM 1021 – HARDSHIP WELL APPLICATION OIL PRODUCED

26. FORM 1021 – HARDSHIP WELL APPLICATION WATER PRODUCED

27. FORM 1021 – HARDSHIP WELL APPLICATION LAST 2 MONTHS – DAYS ONLINE

28. FORM 1021 – HARDSHIP WELL APPLICATION GAS PRODUCED FOR LAST 2 MONTHS

29. FORM 1021 – HARDSHIP WELL APPLICATION OIL PRODUCED FOR LAST 2 MONTHS

30. FORM 1021 – HARDSHIP WELL APPLICATION WATER PRODUCED FOR LAST 2 MONTHS

31. FORM 1021 – HARDSHIP WELL APPLICATION LAST 3 MONTHS – DAYS ONLINE

32. FORM 1021 – HARDSHIP WELL APPLICATION GAS PRODUCED FOR THE LAST 3 MONTHS

33. FORM 1021 – HARDSHIP WELL APPLICATION OIL PRODUCED FOR THE LAST 3 MONTHS

34. FORM 1021 – HARDSHIP WELL APPLICATION WATER PRODUCED FOR THE LAST 3 MONTHS

35. FORM 1021 – HARDSHIP WELL APPLICATION PRODUCTION PROBLEMS – EXPLAIN PROBLEM

36. FORM 1021 – HARDSHIP WELL APPLICATION HAS LOGOFF PRODUCTION TEST BEEN RUN ON THIS WELL

37. FORM 1021 – HARDSHIP WELL APPLICATION IF NO, PLEASE EXPLAIN

38. FORM 1021 – HARDSHIP WELL APPLICATION IF YES, WHAT WERE THE RESULTS OF THE TEST

39. FORM 1021 – HARDSHIP WELL APPLICATION TEST DATE

40. FORM 1021 – HARDSHIP WELL APPLICATION TEST LENGTH

41. FORM 1021 – HARDSHIP WELL APPLICATION NUMBER OF FLOW RATES

42. FORM 1021 – HARDSHIP WELL APPLICATION TEST RESULTS (ENCLOSE A GRAPH OR CHART OF THE RESULTS)

43. FORM 1021 – HARDSHIP WELL APPLICATION MINIMUM RATE NEEDED TO SUSTAIN PRODUCTION IN MCF

44. FORM 1021 – HARDSHIP WELL APPLICATION BARRELS/WATER PER MCF AT MINIMUM RATE

45. FORM 1021 – HARDSHIP WELL APPLICATION WERE THE PIPELINE COMPANY AND THE OFFSET OPERATORS AWARE OF THE LOGOFF TEST

46. FORM 1021 – HARDSHIP WELL APPLICATION ADDITIONAL DATA REQUIREMENTS EXHIBITS ARE REQUIRED. DO NOT SUBMIT THIS FORM WITHOUT YOUR EXHIBITS

47. FORM 1021 – HARDSHIP WELL APPLICATION OPERATOR’S SIGNATURE BLOCK

48. FORM 1021 – HARDSHIP WELL APPLICATION FOR OCC USE ONLY – Do not write below this line