lnstructions OKLAHOMA CORPORATION COMMISSION This form must be filed with the Form 1073

A. Please type or print using black or blue ink. Oil & Gas Conservation Division OCC within 30 days of transit Rev. 2017

B. Form must be signed by former operator and new operator. Post Office Box 52000 of the well.

C. Signatories be listed on their companys Form Oklahoma City, OK 73152-2000

D. Fill in the complete legal description below. FEE: $25.00Transfer of Operator

E. Direct questions to Well Records (405) 521-2271. Single Oil or Gas Well OAC 165:5-3-1(6(tj1N)

OAC 165:10-1-15

API No i \ n , ri -1 ......L- a( % —I -4. .0i-

OTC ProdUnit No.

SurfaceLocation

Sec. 1 Twp 22N Rge 4E SE SE SE

1/4 1/4 1/4 1/4Ft FSL of 330Qtr Sec

Ft FWL of 2310Qtr Sec

County Pawnee

Current Well Diane-Dennis # 1-2Name/NumberOriginal Well 4511,24922--Name/NumberUnit Name(if applicable)Well Class: MOIL [ JGAS EIDRY

(SEE K PAGE FOR AYMENT INFORMATION)

DO NOT WRITE INSIDE THIS BOXOKLA CUkF COPIA

:W23

-15/05/2017 Time: 13:35

Case: 000000000 Cashier: RE

Payor: .7O1iN M PARKSCheck: 34:12 $25.00

50 WELL TRANSFER-OFER

Use this form to transfer stngle oil or gas wells only. Use Form 3MW to transfer 10 or

Specify a we1i0 ND 0 SPI status: (see back page)AC El TA 0 TM

Producingformation(s)

The effective date ofjis the date

transfer of this well, for the purposes of Commission records,that the transfer is ap roved by pie Commission.

CURRENT OPERATOROCC/OTC No. C. tA.901, g--1/ t)

20153 NEW OPERATOROCC/OTC No.

21519Name

Myers Operating

Address PO Box 285

City Pawnee OK

State IZip74058

PhoneNo. 580-623-3500

FAX No./E-mail44110L414,54.9-

I verify that I am the legal operator ofoperatorship of this well, that the facts

and that I have completed this form as

(Signa must be listed on companys

record with authority to transferpresented herein are true and correct,

required by the above instructions.

Form 10068 Operator's Agreement)

Signature.1ND reA /h yet, s - Q...6 0 e .^ - --et Li6 1-1' 4-/,Name & Title (Typed or Printed)

Signed and swom to before me

this 4.1' day 2.,e/ 7 ......,2/ of , .

II

,,._w iCt..4;e1

.......„.___z4-.......A...e..-

Notary PublicI

My commission expires: a / -9 /..70 .._y 04/1

NameOsburn Geralidba Ozzy & Son Oil & Gas- Effie Osburn

Address 11921 S. 513th West Ave

City DrumrightState Zip

OK 74030

PhoneNo. 918-352-4840

FAX No /E-mail

Being the new operator, as of the effective date of transfer,I accept the facts presented as being true and correct and accept the

operational responsibility for the well on the described property.

(Signatory must be listed on company's Form 1006B Operator's Agreement)

_

Name & Title (Typed or Printed)

Signed and swom to before me

C LLIN ,0%.11

ARYMNtK—STATE OF MAKI00111MIS610N * 16011910

2011

l verify under oath that l have exercised due diligence in attempting to locate the current operator of record according to OCC records,who has abandoned the listed well/lease and cannot be located to obtain signature. I have attached a ;led copy of the recorded iease

or assignment, or certified copies of a joumal entry of judgment or bankruptcy pr ing pursuant tp OAC 165:10-1-15(oci

Signed and sworn to before me this

My commission expires:

day of

Sig -6.fr7(9/

FOR OCC USE ONLY

Surety Approved Date

Well

Records

Review:

MU (15 70,17 MAY 05 2017

E. 7,ECORDS. -\ POROVED

U.

Notarv Public

By processing this Form 1073, the Oklahoma CorporationCommission has approved the contents thereof as to torm only. TheOklahoma Corporation Commission does not warrant that the facts

provided by the operator are true.

Transfer is not effective until approvedby the Well Records Department.

Janie Hlinicky

From: Janie HlinickySent: Friday, May 05, 2017 1:54 PMTo: 'CABINWOMAN@FRONTIER.COM'Subject: Well Transfer

To Whom It May Concern,

We have approved the transfer of the Diane-Dennis 1-2, API 117-21922, located in 1-22N-4E from Myers Operating (20153) to

Gerald Osburn dba Ozzy & Son Oil & Gas (21519). An image of the approved form will be available online in the next few days.

Sincerely,

Janie HlinickyOklahoma Corporation CommissionWell Records SectionPhone: 405.521.2271Fax: 405.522.0854i.hlinicky@occemail.com

Oklahoma Corporation Commission

There are new forms for transfers. 1073 for single well, 1073MW for 10+ wells, 10731 for single injection well, 10731MW for

10+ injection wells. Fees for transfers went into effect August 25, 2016. The amounts of the fees are on the forms.

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