Kansas Form Cp 4 PDF Details

Are you living or working in the State of Kansas? Do you need to file form CP-4 with the State of Kansas Department of Revenue? If so, then you’ve come to the right place! In this blog post, we will provide an overview and details regarding Kansas Form CP-4. We will discuss why it’s important to file this form, who should fill it out, and what documents are required when filing. Once completed reading this introductory guide, you'll have all the information that is needed for completing your Kansas Form CP-4 filing requirements successfully.

QuestionAnswer
Form NameKansas Form Cp 4
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescp4 oil wells plugging kansas corporation commission form

Form Preview Example

NOTICE:

Fill out COMPLETELY

and return to Conservation Division at the address below within

60 days from plugging date.

KANSAS CORPORATION COMMISSION

Form CP-4

OIL & GAS CONSERVATION DIVISION

March 2009

Type or Print on this Form

 

WELL PLUGGING RECORD

Form must be Signed

All blanks must be Filled

K.A.R. 82-3-117

 

OPERATOR: License #:

Name:

Address 1:

Address 2:

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

 

 

Zip:

 

 

 

 

+

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Person:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone: (

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oil Well

 

 

 

Gas Well

 

OG

 

 

D&A

 

 

 

 

 

 

Cathodic

 

 

Type of Well: (Check one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Supply Well

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

 

 

SWD Permit #:

 

 

 

 

ENHR Permit #:

 

 

 

 

 

 

 

 

 

 

 

 

Gas Storage Permit #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is ACO-1 filed?

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

If not, is well log attached?

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Producing Formation(s): List All (If needed attach another sheet)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

Bottom:

 

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

 

Bottom:

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

 

 

 

 

 

Depth to Top:

 

 

 

 

 

 

 

Bottom:

 

 

 

 

 

T.D.

 

 

 

 

 

 

 

 

API No. 15 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spot Description:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

-

 

 

 

-

 

 

Sec.

 

 

Twp.

 

 

 

 

S.

R.

 

 

 

 

 

East

 

 

West

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Feet from

 

 

 

 

North /

 

 

 

 

South

Line of Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Feet from

 

 

 

East /

 

 

 

 

West

Line of Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Footages Calculated from Nearest Outside Section Corner:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NE

 

 

 

 

 

 

NW

 

 

SE

 

 

SW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lease Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well #:

 

 

 

 

 

 

 

 

Date Well Completed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The plugging proposal was approved on:

 

 

 

 

 

 

 

 

 

 

 

 

(Date)

by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(KCC DISTRICT Agent’s Name)

Plugging Commenced:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plugging Completed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show depth and thickness of all water, oil and gas formations.

 

Oil, Gas or Water Records

 

Casing Record (Surface, Conductor & Production)

 

 

 

 

 

 

 

 

Formation

 

Content

Casing

 

Size

Setting Depth

Pulled Out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe in detail the manner in which the well is plugged, indicating where the mud fluid was placed and the method or methods used in introducing it into the hole. If cement or other plugs were used, state the character of same depth placed from (bottom), to (top) for each plug set.

Plugging Contractor License #:

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address 1:

 

 

 

 

 

 

 

Address 2:

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

State:

 

Zip:

 

+

 

 

 

 

 

 

 

Phone: (

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Party Responsible for Plugging Fees:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

 

 

 

 

 

County,

 

 

 

 

, ss.

 

 

 

 

 

 

 

 

 

 

 

Employee of Operator or

(Print Name)

Operator on above-described well,

being first duly sworn on oath, says: That I have knowledge of the facts statements, and matters herein contained, and the log of the above-described well is as filed, and the same are true and correct, so help me God.

Signature:

Mail to: KCC - Conservation Division, 130 S. Market - Room 2078, Wichita, Kansas 67202

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It's simple to finish the document with this helpful tutorial! This is what you must do:

1. Complete the Kansas Form Cp 4 with a group of major blanks. Note all the required information and be sure not a single thing forgotten!

Filling in segment 1 of Kansas Form Cp 4

2. Soon after finishing the last part, go on to the next stage and complete the necessary details in these fields - Formation, Content, Casing, Size, Setting Depth, Pulled Out, Describe in detail the manner in, Plugging Contractor License, Address, Name, Address, City State Zip, Phone, and Name of Party Responsible for.

Stage no. 2 of completing Kansas Form Cp 4

Be very attentive while completing Describe in detail the manner in and Size, since this is where most people make some mistakes.

3. The following part is related to Name of Party Responsible for, State of, County, Print Name, Employee of Operator or Operator, being first duly sworn on oath says, the same are true and correct so, Signature, and Mail to KCC Conservation Division - complete these fields.

The way to fill out Kansas Form Cp 4 part 3

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