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

A. Please type or print using black or blue ink.B. Form must be signed by former operator and new operator.

Oil & Gas Conservation DivisionPost Office Box 52000

OCCof the well.

Rev. 2017

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

D. Fill in the complete legal description below. Transfer of Operator FEE: $25.00E. Direct questions to Well Records (405) 521-2271. Single Oil or Gas Well OAC 165 5-3-1 th , 1 Ms11

OAC 165:10-1-15 (SEE BACK PAGE FOR PAYMENT INFORMATION)

API No 147-23266, OTC Prod. 147-074401-0-0000Unit No.

SurfaceLocation

Sec.1

36 Twp 28N Rge 12E SE 1 4 NE 1/4 SE 1/4 1/4Ft FSL ofQtr Sec

1330 Ft FWL of 2366Qtr SecCounty Washington

Current WellName/Number Johnson 1

Original WellName/Number-Unit

Johnson 1

Name(if applicable)

DO NOT WRITE INSIDE THIS BOX

OKLA CORP COI*

RECEIPT 170956OM

Date: 05/0S/2017 Time: 13:1';

Case: 900000000 Cashier: KP?

Payer: DOUGLAS N j0hN3ÐP

Chec4: 9565 $25.0u

58 WELL TRANSFES-OFEF

Well Class MOIL EIGAS ODRY Specify a well status: (see back page) ND El SPE] AC ID TA TM

The stective date of transfer of this well, for the purposes of Commission records,

is the date that the transfer is approv d by tlr)Comm sicr.OCC/OTC No.

RicTgaNE OPECURRENT OPERATOR

Use th

Producingformation(s)

orm to transfer single oil or gas wells only. Use Form 1073MW to transfer 10 or more wrfi .

Name

Address

City State Zip

PhoneNo.

FAX No./E-mail

I verify that l am the legal operator of record with authority to transferoperatorship of this well, that the facts presented herein are true and correct,and that I have completed this form as required by the above instructions.

(Signatory must be listed on companys Form 10068 Operator's Agreement)

Signature

Name & Title (Typed or Printed)

Signed and sworn to before me

this day of , .

Notary PublicMy commission expires:

Bartlesville

IOCCIOTC No.10773-0

Name Johnson Family Trust

Address 10501 N 3940 RD

CityCopan

StateOK

Zip74022

Phone 832-260-4777No.Fax No./E-mail

Being the new operator, as of the effective date of transfer,l accept the facts presented as being true and correct and accept theoperational responsibility for the well on the described property.

(Signatory m st be liste n comp. For • 1006B Operator's Agreement).1t 1

)1-SignatuC

Doug .s N Joh on, Successor Trustee

Name & Title (Typed or Printed)

Signed and sworn to before me

this Li day of Met Li , ab 17 .

‘jnia.kahck t , Tiko,„,k,0Notary Public

My commission expires: iacu4 3 ,ac.)--(-) I verify under oath that I 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 sig ture. l have attached a certified copy of the recorded leaseor assignment, or certified copies of a journal entry of judgment or bankruptcy procee ing pursuant t• OAC 165:1 1-15(b

Si

Signed and sworn to before me this 11 day of httuf0-3 9 .30 My commission expires:

atu

71)4/ikt CriWija4Notarv Pubiic

FOR OCC USE ONLY

Surety Approved Date

WellRecordsReview:

MAY 1 1 7017

__ ::;>,,,/ !--

MAY 1 1 Z017

WELL RECORDSAPPROVED

By processing this Form 1073, the Oklahoma CorporationCommission has approved the contents thereof as to form only. TheOklahoma Corporation Commission does warrant that the facts

provided by the operator are ,rue.

Transfer is not effective until approvedby the Vell Records Department.

ekuosh•auswialiArmeemamibuieboomodlorihre

BARBARA E. THORNBER

Notary Public

State of Oklahoma

Commission * 12004402

My Commission Expires May 3. 2020

This form must be sent, along with payment, to the Cashier at either the Jim Thorpe Office Building in Oklahoma City or the OCC office in Tulsa.

OKLAHOMA CITY MAILING ADDRESS:

Oklahoma Corporation CommissionAttention: Cashier's Office

P 0 Box 52000Oklahoma City, OK 73152-2000

or money orders only)

TULSA MAILING ADDRESS:

Oklahoma Corporation CommissionAttention: Court Clerk's Office440 S. Houston Ave., Suite 114

Tulsa, OK 74127( checks or money orders only)

The information below may be used to hand-deliver this form(and payment by cash, check or money order only) to the Oklahoma City office :

The Jim Thorpe Office Building2101 N. Lincoln Blvd. (Cashier: First Floor)

Oklahoma City, Oklahoma 73105

"WELL STATUS" CODES:

ND (new drill)

SP (spud)

AC (active)

TA (temporarily abandoned/not plugged)

TM (terminated order/UIC well not plugged)

If unable to print form correctly, click "Page Layout" and decrease the "Scale as needed (try 85% first) to print correctly.

Use form to transfer oil or gas wells only. Use to transfer

Print this form in "

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tte,')nfilA0 t,(1fs0111100.

T;OS", ,t tt.410-,00

" ) ( ) orientation

Oklahoma Corporation CommissionOil & Gas Conservation DivisionPO Box 52000Oklahoma City, OK 73152-2000

May 4, 2017

RE: Statement of Fact regarding transfer of the following referenced wells:

API 147-23266-00API 147-23554-00API 147-24000-00API 147-24100-00API 147-24521-00API 147-24809-00API 147-25271-00

The above referenced wells are owned and operated by the Johnson Family Trust on our property that

includes 100% surface and 100% mineral ownership. There is no existing lease on this property and has

been owned by our family since December 1973.

egards,

I! ougla . Johnson, Successor TrusteeJohnson Family Trust10501 N 3940 RDCopan, OK 74022832.260.4777

STATE OF OKLAHOMAQERT1FICATE OF DEATH

STATE FILE NUMBER7.4 Dfcgag.gri,RAI•Nig4q' kikrIlik .,,

ohjtito*.•

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3. SOCIAL SECURITY ER ..., 4. EVER IN LIS ARMED FORCES?

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la RESIDENSEAmp ply Lbws?

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Harvey'-'-. Son. .,

IS, MOTHER'S NAME PRIOR TO 4814ST MARRIAGESIfitlitddle. uiity. -- '•••• •--- .---, ..:'.'.,-: 'Lenora ,.-,„.,,,-- Templetorr?s,- .

aom.g.ppligr NISPANIO4ORIGIN?(000-!Ackthet 84..ftW • - ';',' .--- ' ••._

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1 ,,, .--' RACE (4kinAnnnor rningn‘ts ids* ihitthe decedent considered

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15. DECEDENTS EDUCATION (Chest the *VW Wet deaerthee theNghwt degree wised of sehealweewlded W Ihe Erna of death)

0 Fle wade or*. •...• , ,-,L . • ' , • . , N. .,.„

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13 Associates degree ta.ggiBA$1,,,t. _' ' • '''''

0 D88881114 &Wes (418..1K:FLOSI -`,--., -• "0 Master's degree 44,11E4 5811;WS. 1,1E4MSW, WA)

CI Dostorate (e.g., Pfd3; Ei1D)OrProtessithed Degree (e.g, MD, JD)Mender .„.„„.....„,......

cr (spear).:'...1!;:4- ..".. •le. DEcp:p7p yaw. oc,!,ritial,fikij glycols mag ,9f wading lAiLipo NOT USE RETIRED., ,..;‘.;,, .--..•,, -',..., ;1' :4=4••• . • - ....

17. KIND OF BUSINESS 1 INDUSTRY

Agri.culture,....,..,•-• finonoisHo*tEcoefr.

DOI.Oree.. ..... . -....,,,,.,-,..•

, ......." :'' '

18q. MAILING ADDRESS (Stivet and MIAMI; akAttok4:90.) ,, .,, .,, ...:;:::::::::,,‘,10501 N. 3940 RD. -Coptin,'; CAraahibtati 74022

19. mEtteilif .- -,..„ ..,•

.. . _. E eTniseagnoti Mune of cemetery. crematory. other place) 21.'1.001B914,-.-,BIVT088811WWW8,• - • • . • • •• ..Otittaiii,, _

.1 -1, . '1.•-'-,,,,,2

deb 0 Other (swift - unnyeide Cemetery.... ,•, ,...... -

Caney, .1(ansae.,.:11;rowlisw

9wjp":"11PLE7;AnmEss 01•Flo: FACILITY 23. SIGNATURE OF F9JN_WL1-11,-IRES,Xe.•• .A.4.s.:''.,:,,I,.. -Jo- r• ..S41 Iss,''44,.5. __ o_ e ?Nei .e.: T., 11-----",...__ y ./...." ../..., 1

" . . ER ACTING AS SUCH/ -:

IF DEATFIDCCLIRTIIED IN A141 Inpatient a EmergeneyRoanfOutpiwt Ei Dead on Athol

FACIUTyrIE (Brat thefithion. ono

Caltitt1011 '

34. PART L Enter We darn °F

respiratory w showing the eliabw:MNOT° ABBliEVIA

POIEDIATECABBEFMNIWW8anew dinlbY• ' -

Sewed* kkoindllimto the cause Wad odthe

•

Enter the UNDERLYING OMAR (deiWW'sOr injwy thitle1Whid the averda mike tn .clueS

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4 .3;11 LDOARDPOR Y:

1124t c...89101ER08,0$figivitrl

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Pze 4. ABUSHMENT UCBISEN 101

,,ERFOICE:CIPDEADI (Cho* tidy onw see Inthisolons)

fe.BkH OCCURRWEOMEWHERE OTHER THAN A HOSP1TPL0 Hearin Fealty 0 Nursing honse / Long term eare fasRy Decedent's home Other (Bluth)

21: OR TOW% STATE AND Dp. copE OF LOCATION OF DEATH

.114*:•- Oklahoma 74006mEof?rosikstetcommerED lavas-AN AlJTOPSY PERFORMED?

p Yee (No

004.3 tusk a s Nam westonly ant owpe an a kw Aild MIMI Was If nevem:my.

28. COUNTY OF DEATH

liashington33. WERE ALIIDPSY FINDINGS AVAILABLE TO COMPLETE

THE CAUSE OF DEATH?

[rfee aNe

Don Inform a ounsequanoe

Approakashiwkwat,Owed to Dadh

115. PART IL Enter othejlnirtot *WAN* Wnft to

e

milky Oti

cause given,

Sfi.v4t-60‘,.

38. DID TOBACCO USE CONTRIBUTE_)iliBdIrae4 OA Nat pregnant, but pregmant within 42 drrys of death TODEFIN?

Nck' la' 40,14,;doe 1 0 Unknown VI:regnant wthin the past year RSPB ItINo 0 Probably °Unknown

41. PLACE'DiINAJRY . construcen de wooded area) 42. DESCRIBE HOW INJURY OCCURRED; 43. INJURY AT WORK?

El Yea Q No

PAEDICAi EXAMINER OtHhe beds of mouninatIon ender Investigaltnii; in rw widen, death mewed gibe Wee, die, e4fa4 WO &loth Ift4sFus, 8(e)

x.11-fr

sPEOarcki*

Nowlsec

45. IF TRANSPORTATION INAIRY. SPECIFY:

Darer / Operator [Passenger [Peas:than

❑ Other fiPeciy) ...:43.14PME, ADDRESS AND ZIP CODE OF PERSON COMPLETING CAUSE OF DEATH Stern 34)

14e44C/44- 61C.1 / 1'4

3,4crolac.e4r-Z ic

48. UCENSE NUMB 4.9. DATE DEATH C

51. DATE RECEIVED BV,LOCAL REGIS1RA3

:j1110.0.2010

r)

BY SPLIE REGISTRAR

(Mo/Deyff r)

B01454368

This is a true and correct of'the official recOra on file in, frhe Office, o

Vital Statistics, Oklahoma ;Oklahoma, certifiecton the dge.stam

Kelly M. BakerState !RegistrarOffice of Vital Statistici.Department of. Health : •

„. • . .violation bklahoiiitt Stamtea; Tide • 8etiti!*1-32 ; r'lisoo

ciogoitei ,tkNeh -, otivOtO• to bo: oiiieiial,•;'eertified copy copy of a Ortifiogtej,of 0*

• or still*th,.ekeept' a.SY atithorizOd •in lhia act or rtilig..,and•t•egt.t4tiOn...adOPtpd'Inidit

CERTIFIED COPIES WILL BE PRODUCED ONSULTI-COLOR SECURITY Plii*

VERIFY PRESENCE OF WATERMARK HOLD TO LIGHT TO VIEW

: THIS DOCUMENT IS PRINTED ON SECURITY WATERMARKED PAPEIT AND CONTAINS.AEquarre FIBERS.,

DO.NOT ACCEPT vonotr VERIFYING THE PRESENCE Op THE WATERMARK •

THE DOCUMENT FACE CONTAINS A SECURITY BACKGRCUND,THE BACK CONTA

INS SPEOAL 14Neavirni•

i

Janie Hlinicky

From: Janie HlinickySent: Thursday, May 11, 2017 12:08 PMTo: 'eezzride@verizon.netSubject: Well Transfers

To Whom It May Concern,

We have approved the transfer of the 7 wells listed below to Johnson Family Trust (10773).

147-23266 JOHNSON 1 35-28N-12E

147-23554 JOHNSON 2 35-28N-12E

147-24000 J R JOHNSON 3 35-28N-12E

147-24100 J R JOHNSON 4 35-28N-12E

147-24521 J R JOHNSON 5 35-28N-12E

147-24809 J R JOHNSON 6 35-28N-12E

147-25271 J R JOHNSON 7 35-28N-12E

images of the approved forms will be available online in the next few days.

Sincerely,

Janie HlinickyOklahoma Corporation CommissionWell Records SectionPhone: 405.521.2271Fax: 405.522.0854

i.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.

1