Form 1004D PDF Details

In the realm of the Alaska Oil and Gas Conservation Commission's regulatory framework, the 1004D form stands as a critical document for operators within the state's oil and gas industry. Serving as a bond, it embodies a financial guarantee from operators to the Commission, ensuring adherence to the state laws, regulations, rules, and orders related to the drilling, operation, maintenance, repair, and abandonment of wells, along with the clearance of each location. Bonds, as articulated in the form, can be presented through multiple mediums - a Certificate of Deposit, an Irrevocable Letter of Credit, or other Commission-approved securities - offering flexibility in compliance. The document delineates specifics regarding the minimum penal sum required, which varies based on the operation's scope, either as a single well bond or a blanket bond covering multiple wells. Moreover, it highlights the continuous obligation of the operator to comply with all regulatory requirements until officially released by the Commission. Through these measures, the form plays a pivotal role in safeguarding environmental standards and operational integrity within Alaska's vital oil and gas sector.

QuestionAnswer
Form NameForm 1004D
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesappraisal 1004d, 1004 d, inspection form 1004d, fannie mae 1004d form

Form Preview Example

STATE OF ALASKA

ALASKA OIL AND GAS CONSERVATION COMMISSION

 

 

 

 

PERSONAL BOND

 

BOND NUMBER

 

 

 

PENAL SUM $

 

 

 

 

 

KNOW ALL PERSONS BY THESE PRESENTS,

 

That

 

 

 

 

 

 

,

of the City of

 

 

, State of

 

,

as operator, is held firmly bound unto the Alaska Oil and Gas Conservation Commission in the penal sum as indicated above, lawful money of the United States of America, for which payment, well and

truly to be made, the operator binds itself and its heirs, executors, administrators, successors, and assigns, firmly by these presents. The operator’s performance under this bond is guaranteed by the

following security, the disposition of which shall be solely determined by the Alaska Oil and Gas Conservation Commission until released by said Commission.

The attached Certificate of Deposit No.

 

issued in sole favor of

 

the Alaska Oil and Gas Conservation Commission by

 

 

,

 

a bank authorized to do business in the State of Alaska.

 

 

The attached Irrevocable Letter of Credit issued in sole favor of the Alaska Oil and

Gas Conservation Commission by

 

,

a bank authorized to do business in the State of Alaska.

 

[Description of other approved security:]

WHEREAS the above bounden operator proposes to engage in the drilling or operating of a well or wells subject to regulation by the Alaska Oil and Gas Conservation Commission at a location described as follows:

☐ SINGLE WELL BOND - minimum penal sum $100,000 (except as otherwise allowed by the Commission under 20 AAC 25.025(b))

Unit or Lease Name Well Number Area of State

Surface Well Location - Sec., Twp., Rng. and Mer.

Surface Well Location - Alaska State Plane Coordinate System coordinates

☐ BLANKET BOND - minimum penal sum $200,000

Any and all wells drilled or operated by the operator in the State of Alaska.

Form 10-402B Rev. 05/2012

Page 1 of 2

Submit in Duplicate

BOND NUMBER

 

(continued) PENAL SUM $

NOW, THEREFORE, the above bounden operator shall comply with all of the provisions of the laws of the State of Alaska and the regulations, rules, and orders of the Alaska Oil and Gas Conservation Commission in the drilling, operation, maintenance, repair, and abandonment of each well and the clearance of each location, and shall file with the Alaska Oil and Gas Conservation Commission all notices and records required by said Commission.

This obligation shall remain in full force and effect until released by the Alaska Oil and Gas Conservation Commission in accordance with 20 AAC 25.025(c).

 

Witness our hand and seal this

 

 

 

day of

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Operator

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Printed name and title

 

ACKNOWLEDGEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Judicial District (or County of

 

 

 

 

 

 

 

 

 

)

 

 

 

 

 

 

 

 

 

 

The foregoing instrument was acknowledged before me on this

 

 

 

 

day of

 

 

 

 

 

 

, by

 

 

 

 

 

(name)

 

 

 

 

 

 

 

 

 

 

 

 

(title) of

 

 

 

 

 

 

 

(operator), on behalf of

 

 

 

 

 

 

 

 

 

 

 

(operator).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notary Public in and for

 

My commission expires:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Official Use Only Below Line

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALASKA OIL AND GAS CONSERVATION COMMISSION

Approved:

 

 

 

Commissioner

 

Date

Approved:

 

 

 

Commissioner

 

Date

Approved:

 

 

 

Commissioner

 

Date

(Requires approval by two Commissioners)

 

 

Form 10-402B Rev. 05/2012

Page 2 of 2

Submit in Duplicate

How to Edit Form 1004D Online for Free

We've applied the efforts of the best programmers to create the PDF editor you may want to take advantage of. The app will permit you to fill out the 1004d appraisal file effortlessly and don’t waste valuable time. All you should undertake is follow these straightforward instructions.

Step 1: Select the button "Get Form Here".

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These particular parts are in the PDF file you'll be completing.

part 1 to completing what is a 1004d

In the Description of other approved, WHEREAS the above bounden operator, SINGLE WELL BOND minimum penal, by the Commission under AAC b, Unit or Lease Name Well Number, Surface Well Location Sec Twp Rng, Surface Well Location Alaska, BLANKET BOND, minimum penal sum, and Any and all wells drilled or box, note down your data.

what is a 1004d Description of other approved, WHEREAS the above bounden operator, SINGLE WELL BOND  minimum penal, by the Commission under  AAC b, Unit or Lease Name Well Number, Surface Well Location  Sec Twp Rng, Surface Well Location  Alaska, BLANKET BOND, minimum penal sum, and Any and all wells drilled or fields to fill

Make sure you emphasize the vital data from the BOND NUMBER, continued PENAL SUM, NOW THEREFORE the above bounden, This obligation shall remain in, Witness our hand and seal this, day of, Operator, ACKNOWLEDGEMENT, Signature, and Printed name and title area.

part 3 to filling out what is a 1004d

Within the part ACKNOWLEDGEMENT, State of, Judicial District or County of, The foregoing instrument was, day of, name, operator on behalf of, title of, operator, My commission expires, Notary Public in and for, Official Use Only Below Line, ALASKA OIL AND GAS CONSERVATION, and Approved, place the rights and responsibilities of the sides.

what is a 1004d ACKNOWLEDGEMENT, State of, Judicial District or County of, The foregoing instrument was, day of, name, operator on behalf of, title of, operator, My commission expires, Notary Public in and for, Official Use Only Below Line, ALASKA OIL AND GAS CONSERVATION, and Approved fields to fill out

Finish the form by looking at the next sections: Approved, Approved, Approved, Requires approval by two, Commissioner, Commissioner, Commissioner, Date, Date, Date, Form B Rev, Page of, and Submit in Duplicate.

what is a 1004d Approved, Approved, Approved, Requires approval by two, Commissioner, Commissioner, Commissioner, Date, Date, Date, Form B Rev, Page  of, and Submit in Duplicate blanks to complete

Step 3: Choose the "Done" button. Then, you can transfer your PDF file - save it to your device or forward it by means of electronic mail.

Step 4: Ensure that you stay away from future problems by getting as much as a couple of copies of the form.

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