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Get STATE OF LOUISIANA OFFICE OF CONSERVATION

) OF BEFORE ME, the undersigned authority, duly commissioned and qualified within and for the State and Parish (County) aforesaid, personally came and appeared (NAME) who, being by me first duly sworn, deposed and said: That he / she is the of (TITLE) , applicant for Serial No. (APPLICANT) , and in that capacity (SN) he/she is requesting the Commissioner of Conservation of the State of Louisiana to determine the status of said well pursuant to LSA - R.S. 47:648 et seq. That the well was spu.

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