REQUEST FOR CHANGE OF OWNER (Form 7)

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Request for Change of Owner (Form 7)

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Page 1 of 2

DIVISION USE ONLY

ASSIGNEE/TRANSFEREE:

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Chapter 1509 of the Revised Code

and must comply with all laws, rules and orders

by the

Chief of the Division of Oil and Gas

Resources Management.

Further, I understand that the Division does not determine property rights. I understand that if another person has a competing interest in

this well that it is a private legal dispute. The Division cannot adjudicate the dispute.

___________________________________________________ ___________________________________________________

Signature of Assignee/Transferee

Name of Assignee/Transferee Printed or Typed

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REQUEST FOR CHANGE OF OWNER (Form 7)

OHIO DEPARTMENT OF NATURAL RESOURCES

Division of Oil and Gas Resources Management

2045 Morse Road, Bldg. F-2 • Columbus, OH 43229-6693 • (614) 265-6922

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THE ABOVE.

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STATUS

WELL NO./

PROD.

NON-

PROD.

LEASE NAME

Indicate under the status column whether the wells listed are producing or non-producing.

API COUNTY TOWNSHIP SEC./LOT

Request for Change of Owner (Form 7)

'155HY19

Page 2 of 2

Request for Change of Owner (Form 7) - INSTRUCTIONS

The Division of Oil and Gas Resources Management has revised Request for Change of Owner (Form 7). State law

requires this form to be submitted to the Division within thirty (30) days after the date of assignment or transfer of a

well (see Section 1509.31(A) of the Ohio Revised Code).

The assignor/transferor is the individual or entity selling or transferring the well. The assignee/transferee is the

individual or entity buying the well or becoming the owner as defined under section 1509.01(K) of the Ohio Revised

Code (“ORC”). It is the assignor’s/transferor’s responsibility to ensure that the form is completed and submitted to the

Division because the assignor/transferor is liable under ORC Chapter 1509 and Chapter 1501 of the Ohio

Administrative Code (“OAC”) until all of the following occur:

(1) a complete Form 7 is filed with the Division;

(2) the assignee/transferee has met the insurance requirements found in ORC 1509.07(A); and

(3) the assignee/transferee has met the financial assurance requirements found in ORC 1509.07(B).

The permit number must be on the form. This number can be taken directly from the permit. Both parties must

complete and notarize the form before it is forwarded to the Division. The transfer must be the original copy and may

be used to transfer an individual well or multiple wells.

UNDER ORC 1509.07(A)(3) AND 1509.31(C), SUBMITTING TO THE DIVISION THE ATTACHED FORM DOES

NOT ALONE RELIEVE THE ASSIGNOR/TRANSFEROR OF RESPONSIBILITY TO MAINTAIN INSURANCE OR

BOND FOR THE LISTED WELL(S). IF THE ASSIGNEE/TRANSFEREE HAS NOT OBTAINED THE PROPER

INSURANCE OR BOND IN ACCORDANCE WITH ORC 1509.07(A) OR (B), OR THE ASSIGNEE/TRANSFEREE IS

IN MATERIAL AND SUBSTANTIAL VIOLATION OF ORC CHAPTER 1509 OR OAC CHAPTER 1501, THEN THE

ASSIGNOR/TRANSFEROR MUST CONTINUE TO MAINTAIN INSURANCE OR BOND FOR THE LISTED WELL(S).

ITEM 16 - Exempt Domestic Well. If yes is checked, the following criteria must be met.

1. The well is owned by the owner of the surface estate of the tract on which the well is located. In other words,

the person(s) signing this form must own the property and rights to appropriate the gas for their own use.

2. The well must be used to primarily provide gas for the owners’ DOMESTIC use. Wells primarily to supply gas

to rental properties; residences adjacent to the tract on which the well is located; or businesses do not qualify

as domestic wells.

3. The well must be more than 200 feet from any inhabited private dwelling house other than an inhabited

private dwelling house located on the tract on which the well is located.

4. The well must be more than 200 feet from any public building.

5. The owner must maintain the well at their own expense to maintain productivity, properly dispose of brine,

plug the well when it is no longer capable of production and restore the well site.

In addition to the domestic criteria listed above, the person who will become the exempt domestic well owner must

post a five-thousand dollar bond ($5,000) with the Division prior to the transfer, if either of the following applies:

• The tract that results from merging the well with the surface tract is less than five acres; or

• The assignor/transferor has not released all of the oil and gas leases that are included in the applicable

formation of the drilling unit.

If the assignor/transferor has released the oil and gas lease(s) associated with the well(s) that is proposed to be

assigned or otherwise transferred, the assignor/transferor must submit an Exempt Domestic Well Owner Affidavit

– Release of Lease(s).

Requ

est for Change of Owner (Form 7) - Instructions

'155HY19