HomeMy WebLinkAboutR-2015-079 2015-05-11RESOLUTION NO. R2015-79 A Resolution of the City Council of the City of Pearland, Texas, authorizing an Oil and Gas Drilling Permit for Denbury Onshore in the vicinity of SH35 and Hastings Oil Field. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That Denbury Onshore has submitted the Oil and Gas Drilling Permit attached hereto as Exhibit "A". Section 2. That Denbury Onshore has complied with the requirements of the City Oil and Gas Ordinance. Section 3. That the City Council hereby approves as Oil and Gas Permit for Denbury Onshore. PASSED, APPROVED and ADOPTED this the 11th day of May, A.D.. 2015. ATTEST: NG LI TR SECTARY APPROVED AS TO FORM: DARRIN M. COKER CITY ATTORNEY PI -7 TOM REID MAYOR ''',''11111 1 11 ONO''`` Denbury 0 March 11, 2015 City of Pearland Young Lorfing, City Secretary 3519 Liberty Drive Pearland, TX 77581 Re: Denbury Onshore, LLC Oil & Gas Well Permit to Drill Application Hastings Community Lease HCL #1402R Mr. Lorfing, RESOLUTION NO. R2015-79 Exhibit "A" Sent Via Federal Express 7731 0226 8930 Denbury Onshore, LLC respectfully submits two copies of the enclosed oil and gas permit to drill application for the HCL #1402R. Please note Denbury plans to utilize an existing hole that was drilled alongside the HCL #1402 to perform plugging operations Due to problems with the wellbore. the only way to access and properly plug this well was to drill a new hole alongside the existing well and pump cement into the old casing. This was successfully accomplished in December 2014 and at the time Denbury had not evaluated the new hole for any use other than to plug the existing well. However, we now see an opportunity to utilize the new hole as a potential oil producer. By using the existing hole that was drilled as a means of plugging HCL #1402 rather than drilling a completely new well, Denbury would be able to reduce surface disturbance as well as reduce the amount of time that a rig would be active on the location. The hole would only need to be deepened by approximately 500'. Please contact me at 972-673-2778 if you have any questions or need additional information. Sincerely, Eric Linthicum Regulatory Specialist Enclosures 1 Denbury Resources Inc. 5320 Legacy Drive • Plano, Texas 75024 • Tel 972 673 2000 • denbury.com 1 Subsidiaries Denbury Onshore, LLC • Denbury Green Pipeline Texas LLC • Oenbury Gulf Coast Pipelines. LLC • Denbury Pipeline Company LLC PAY EXACTLY 1 $2,500.00 EC S '_' ' ` O ` •' C7 E P • PER ITH TRUE ATERMARKS & VISIBLE FIBERS ON FRO, & BACK. VOID SECURITY' BACKGROUND AND MICROPRINT_SIGNATURE LINE PAY TO THE ORDER OF DENBURY 5320 Legacy Drive Plano, Texas 75024-3121 Two thousand five hundred and 00/100 Dollars CITY OF PEARLAND 3519 LIBERTY DRIVE PEARLAND, TX 77581 JPMorgan Chase Bank, NA San Angelo, Texas 88-88/1113 `ATE 11/06/2014 CHECK NO. 0000666468 ezi4/-44-‹ at VENDOR NO. : VENDOR NAME: 11'000066646811' I: L L 13008801: 931,996037e 1070059630 CITY OF PEARLAND DENBURY ONSHORE LLC PLANO, TX DATE: CHECK #: 11/06/2014 0000666468 VOUCHER TOTAL PRIOR PMTS NET NUMBER VENDOR INV # INV DATE COMMENT AMOUNT & DISCOUNTS AMOUNT 9100215574 103114CP 10/13/2014 DRILLING PERMITS 2,500.00 2,500.00 TOTAL INVOICES PAID 52,500.00 City of Pearland Drilling Permit Application Attn: Young Lorfing, City Secretary Date: March 11, 2015 Applicant: Denbury Onshore, LLC 5320 Legacy Drive Plano, Texas 75024 A Delaware, Limited Liability Corporation Location: Hastings Community Lease #1402R Northing (Y)=632.451.82" Easting (X)=3,188,092.23 (Texas State Plane, NAD 27, Texas South Central) Well Type: Surveyor's Plat attached as Exhibit: A This well will be drilled to a proposed total depth of 6500'. Once this well is drilled and completed, it will be utilized as either an oil producer or injection well. This well will be completed within the Frio Complex of sands. 5. Well Plan and Casing Program: Attached as Exhibit: B Start Date: Proposed April 15, 2015, but will commence ASAP after City permit is obtained. Access: All access to the drill site will be off of State Hwy 35 and private company owned and maintained lease roads. No City streets will be utilized. Pipelines: The new pipeline to serve this well wi'.1 follow existing pipeline routes exiting the subject tract to the West and leaving the City limits to the West within 150' from the new well location. 9. Rig Type: Workover 10. Interest Owners: Attached as Exhibit: C 13. Fencing: Nc additional fencing will be installed, as the location is on private property behind existing fences with gated entry. 14. Restoration: 75% of the drill pad site will be stripped of its base rock to be used in other area of the field for road and other sites. The cleaned area will be reseeded and allowed to return to pastureland. 1 ADDITIONAL ATTACHMENTS Exhibit Description E Surveyor's Plat showing 1000' Radius from Wellbore F Texas Railroad Commission Form W-1 G Survey of Public Road Impact H Environmental Report Oil and Gas Lease for Tract 12 J Standard Drilling Contract K Copy of Operating Agreement for WHU L Texas Water Board Letter Applicants Comments: As part of this application, Denbury respectfully requests that special consideration and exceptions be considered by the City Council. In Article 2, Section 21-26 of the City's Drilling Ordinance, it states that the council may exempt the applicant from certain requirements found within the ordinance. We have the following requests for exemption. Art III, Section 21-40: ...no tripping operations between lOpm and 7am Art III, Section 21-39: Permitted Hours for delivery and removal of material Normal time for drilling in this field requires 18-24 days of drilling operations. Due to the fact that the ordinance specifies a closed mud system instead of the conventional open reserve pits, the delivery of drilling mud/additives and the removal of excess drilling fluids cannot be safely restricted to daylight hours only. If these materials are required, they are typically ordered as needed as the borehole conditions dictate. Storing these materials at the drill site would require construction of a larger pad and additional disturbance to the owner's surface acreage. The same concern surrounds the restriction of tripping operations between the hours of 10 pm and 7 am. The necessity for making such trips is determined by the condition of the equipment and wellbore. The shut down of drilling operations for 9 -hour periods each night would extend the overall drilling time as much as 35 2 percent and risk the integrity of the open hole during the time drilling is suspended. This extension of rig time is not only an extension of the length of potential disruption to nearby residents, but it would add a considerable amount to the costs associated with the drilling operations. In addition, safety risks are added by leaving the drill string and equipment downhole while suspending drilling and tripping activities. The location of this well is in a sparsely developed area and more than 1500' from the nearest residence. Due to this distance. disturbances to any residents from 24-hour drilling operations would be very low. Your consideration of exemptions to these two ordinance requirements is appreciated. APPLI TS SIGNATURE Date Eric Linthicum Regulatory Compliance Specialist Denbury Onshore, LLC 972-673-2778 Eric Linthicum@Denbury.com 3 EXHIBIT i SURVEYOR'S PLAT Imin es SURVEY Litt J z w HASTINGS COMMUNITY LASE LINEN SURVEY UNE Hoehn q" Conm„mty 303.93 Acre, z 203 C 0' 1402R b NCL 10 10 02 B1eL ( 167 to West Survey Lino 1' to West_ 199' to South Unit Line H.T.&B. RR SECTION 27 A-308 G.C. SMITH SECTION 30 A— 552 11 1s c :vino W. 'p.nbury °natw(.. U.C. Meeh v Comm. -Ay Loc. 1002 HASTINGS COMMUNITY LEASE UN WEST HASTINGS UNIT UNE HASTINGS COMMUNITY LEASE UNE G.C. SMITH SECTION 28 A-551 SURVEY UNE H.T.&B. RR SECTION 29 A-292 0 1000 • Propsed Well 'Denbury Onshore, LLC, Hastings Community Leaee No. 1402R` Surfoce Hole Location Elevation 43.4' Y: 632.451.82' X: 3,188,092.23' Lotitude: 29.520596 N Longitude 095.263581 W 2000 1"=1000, W.M. SNIDER A — 370 ELLIS SURVEYING SERVICES 8419 Emmett F. Lowry Texas City, Texas 77591 409.938.8700 Texas Registration No. 100340.00 1 \ A.C.H.& 8. SECTION 1 A — 4 1 6 NOTES: 1. COORDINATES AND BEARINGS BASED ON GRID NORTH TEXAS PLANE COORDINATE SYSTEM SOUTH CENTRAL ZONE (NAD 27). 2. WELL LOCATED N09.44'39"E" 2.0 MILES FROM THE CITY OE PEARLAND CITY HALL 3. LEASE AND TRACT INFORMATION SHOWN HEREON IS DONE 50 BY DEED RECORD INFORMATION ONLY AND LIMITED SURVEY DATA AND DOES NOT REFLECT AN ACTUAL SURVEY. 1, SCOTT D. ELWS, REGISTERED PROFESSIONAL LANO SURVEYOR NO. 6261, DO HEREBY CERTIFY THAT THIS PLAT CORRECTLY REPRESENTS THE PROPOSED WELL LOCATION AS SHOWN HEREON TO THE BEST OF MY KNOWLEDGE AND BEUEF. WELL LOCATION PLAT PREPARED June. 09.2014. SCOTT D. ELLIS R.P.t.S NO. 6261 PROPOSED WELL LOCATION PLAT DENBURY ONSHORE, LLC HASTINGS COMMUNITY LEASE NO. 1402R G.C. SMITH SURVEY Section 28 A-551 BRAZORIA COUNTY, TEXAS EXHIBIT «B„ WELL PLAN AND CASING PROGRAM Danbury 6 Currently Selected Schematic HCl #1402R (TWINNING) ars Li 95't5'49635"W Most Recent Jot. .ot PI,p &Abandon Rrrr/Jo) trot Abandon Wel Stcx'w, Jx TrR plug and Abandon Operators x -.e1 12/11/1014 M:n 12/21/2014 70: 6,400.0 Ongnal Hole 2/1623154 CO 42 Ptd Vertical schematic (proposed. Tudno 2 7/8. 6 SO: ,i-56. 18 27.888 6-- 140C-6 4C0 -- 40 --6400 Prod osedCement toner Cement 180-6 400 Proposed CementCementkua n T•i 0escnption.Conductor.0016: Wt'8400 GradeJ- 55: Depth (MD) -18.5-98.5 Description :Surlace:00:95/8. Wt. 36 00. Grade) 55 Depth (MD).18.46-1.208 5.433.5.436: Pert 5.458-5,461. Pert —5 478.5.481: Perf 5 503-5.506: Pert 5.550-5.553: Peri 5 590-5.593. Perf www.peloton.com Page 131 Description :Production. 00:7: Wt.:23 00. GradeJ- 55: Depth (MD) 18.5.5.900 Dasa ption.Lrner: 00.5.' W1 18 00.Grade J-56 Depth (MD) 5.400-6,400 Report Pnnted: 2;162016 EXHIBIT WORKING INTEREST OWNERS WI Owners List Denbury Onshore, LLC 5320 Legacy Drive Plano, Texas 75024 Exxon Mobil Corporation P.O. Box 4707 Houston, Texas 77210-4707 89.817400% 09.716680% Private Individuals 00.046592% EXHIBIT "D„ DRILLING MANAGEMENT Mark Menzies, Drilling Engineer Office: 5320 Legacy Drive, Rm: 1.3.118 Plano, TX 75024 Email: mark.menzies()denbury.com Ph: 972.673.2955 Education: Texas A&M University, Bachelor of Science in Petroleum Engineering - 1998, plus numerous industry schools and other training. Well Control certification is current through August 2015 (Supervisory level). Experience: 16 years of drilling experience in planning, operations and wellsite supervision. Experience on vertical and directional wells in the following areas: West TX, East TX, New Mexico, Pennsylvania (Marcellus horizontal wells), North Louisiana (Haynesville HTHP horizontal wells), South Louisiana including onshore and inland waters, North Dakota EXHIBIT !! E l! SURVEYOR'S PLAT WITH 1000' RADIUS ZYCHUNSAT SUf>OMSOV VOLUME 29, PAGE 9, B.CN.R. H.T.t9. RR SECTION 27 A- 309 O.C. SMITH SECTION 28 A-551 LOT 173 ALEXANDER JOIN FATLY TASTED PARMERSHP PROPERTY D / 109395 ALEXANDER JOHN FAMILY LLIITED PARTNERS!". PROPERTY D / 178192 ALEXANDER JOHN EMILY LIMITED PARTHERSI". PROPERTY ID 1 1683915 MDU/IDER JOIN EMILY LOTTED PARTNERS!". PROPERTY D / 188394 ALEXANDER J01111 FMLY LIMITED PARTNERSHIP PROPERTY ID / 178192 M.D(NIOER JOHN FAMILY LAMED PARTNERSHP PROPERTY D / 178199 PROPOSED WELL 1402R 2.08 ACRE PAD SITE H.T.l8. RR SECTION 27 A-308 O'DAY PAT LRS ESTATE PROPERTY D / 198409 A: 178239 VOL 205 PG 398 8.C.D.R. MNi10 A IMO OCHO4 PEREZ Prearty D % 178238 G.C. SMITH SECTION 28 A-551 AKA H.T.88. RR SECTION 28 EXHIBIT "F" TEXAS RAILROAD COMMISSION FORM W-1 API No. 42-039-33219 RAILROAD COMMISSION OF TEXAS FORM W-1 07/2004 Drill ingPermit A 790944 OIL & GAS DIVISION PERMIT TO DRILL, Permit Status: Approved SWR Exception Case/Docket No. APPLICATION FOR RECOMPLETE, OR RE-ENTER This facsimile W -I was generated electronically from data submitted o the RRC. A data is in RRC's Austin certification of the automated available the office. 1. RRC Operator No. 215343 2. Operator's Name (as shown on form P-5, Organization Report) DENBURY ONSHORE, LLC 3. Operator Address (include street, city, state. zip). 5320 LEGACY DRIVE PLANO, TX 75024-0000 4. Lease Name HASTINGS COMMUNITY LEASE 5 Well No. 14028 GENERAL INFORMATION 6. l'urposc of filing (mark AI.I. appropriate boxes): i?7 New Drill • Recompletion • Reclass • Field Transfer 0 Re -Enter 0 Amended • Amended as Drilled (BHL) (Also File Form W -1 D) 7. Wellbore Profile (mark ALL appropriate boxes): ®Vertical • Horizontal (Also File Form W - III) III Directional (Also File Form W - I ID) IN Sidetrack 8. Total Depth 6400 9. Do you have the right to develop the 0• minerals under any right-of-way ? Yes No 110. Is this well subject to Statewide Rulc 36 (hydrogen sulfide area)? 0 Yes 173 No ?.SURFACE.LOCATIONAND.ACREAGE'INFORMATION ,.. . 11. RRC District No. 03 12. County BRAZORIA 13. Surface Location ® Land ❑ Bay/Estuary III Inland Waterway • Offshore 14. This well is to be located 2 miles in a NE direction from Pearland which is the nearest town in the county of the well site. 15. Section 28 16. Block 17. Survey I HT&B RR CO/SMITH, G C 18. Abstract No. A-551 19. Distance to nearest lease line: 199 ft. 20. Number of contiguous acres in lease, pooled unit, or unitized tract: 303.93 21. Lease Perpendiculars: 1261 fl from the W Zinc and 199 11 from the S line. 22. Survey Perpendiculars: 1664 11 from the S line end 167 n from the W line. 23. Is this a pooled unit? 0 yes A No 24. Unitization Docket No: 25. Are you applying for Substandard Acreage Field? • Ycs (attach Form W- 1 A) ® No FIELD INFORMATION :' `List all fields ofanticipated completion including Wildcat List one zone.perline. 26. RRC District No. 27. Field No. 28. Field Name (exactly as shown in RRC records) 29. Well Type 30. Completion Depth 31. Distance to Nearest Well in this Reservoir 32. Number of Wells on this kasc in this Reservoir 03 39603001 HASTINGS, WEST Oil Well 1 2036.00 3 BOTTOMHOLE LOCATION INFORMATION is required for DIRECTIONAL HORIZONTAL, AND AMENDED AS DRILLED PERMITAPPLICATIONS Remarks Certificate* I certify that information stated in this application is true and complete, to the best of my knowledge. Eric Linthicum, Regulatory Specialist Jul 03, 2014 9 ry p [RRC STAFF Jul 28, 2014 10:12 AM): There have been problems identified with this permit (see problem letter attachment). Notification sent.; [RRC STAFF Jul 28, 2014 3:11 PM]: Problems identified with this permit are resolved.; (RRC STAFF Aug 6, 2014 7:28 AM]: There have been problems Identified with this permit (see problem letter attachment). Notification sent.: [RRC STAFF Aug 6, 2014 9:47 AM]: Problems identified with this permit are resolved.; [RRC STAFF Aug 6, 2014 9:47 AM): As per Eric Linthlcum: The Pat Oday #2 was PMA on 4/16/2014. Name of filer Date submitted (972)673-2778 eric.linthicumta7.denbury.com RRC Use Only Data Validation Time Stamp: Aug 6, 2014 9:52 AM( Current Version) Phone E-mail Address (OPTIONAL) Page 1 of 1 Railroad Commission of Texas PERMIT TO DRILL, RE -COMPLETE, OR RE-ENTER ON REGULAR OR ADMINISTRATIVE EXCEPTION LOCATION CONDITIONS AND INSTRUCTIONS Permit Invalidation. It is the operator's responsibility to make sure that the permitted location complies with Commission density and spacing rules in effect on the spud date. The permit becomes invalid automatically if, because of a field rule change or the drilling of another well, the stated location is not in compliance with Commission Feld rules on the spud date. If this occurs, application for an exception to Statewide Rules 37 and 38 must be made and a special permit granted prior to spudding. Failure to do so may result in an allowable not being assigned and/or enforcement procedures being initiated. Notice Requirements. Per H.B 630, signed May 8, 2007, the operator is required to provide notice to the surface owner no later than the 15th business day after the Commission issues a permit to drill. Please refer to subchapter Q Sec. 91.751-91.755 of the Texas Natural Resources Code for applicability. Permit expiration. This permit expires two (2) years from the date of issuance shown on the original permit. The permit period will not be extended. Drilling Permit Number. The drilling permit number shown on the permit MUST be given as a reference with any notification to the district (sec below), correspondence, or application concerning this permit. Rule 37 Exception Permits. This Statewide Rule 37 exception permit is granted under either provision Rule 37 (h)(2)(A) or 37(h)(2XB). Be advised that a permit granted under Rule 37(h)(2)(A), notice of application, is subject to the General Rules of Practice and Procedures and if a protest is received under Section 1.3, "Filing of Documents," and/or Section 1.4, "Computation of Time," the permit may be deemed invalid. Before Drilling Fresh Water Sand Protection. The operator must set and cement sufficient surface casing to protect all usable -quality water, as defined by the Railroad Commission of Texas (RRC) Groundwater Advisory Unit (GWAU). Before drilling a well, the operator must obtain a letter from the Railroad Commission of Texas stating the depth to which water needs protection, Write: Railroad Commission of Texas, Groundwater Advisory Unit (GWAU), P.O. Box 12967, Austin, TX 78711-3087. File a copy of the letter with the appropriate district office. Accessing the Well Site. If an OPERATOR, well equipment TRANSPORTER or WELL service provider must access the well site from a roadway on the state highway system (Interstate, U.S. Highway, State Highway, Farm -to -Market Road, Ranch -to -Market Road, etc.), an access permit is required from TxDOT. Permit applications are submitted to the respective TxDOT Area Office serving the county where the well is located. Water Transport to Well Site. If an operator intends to transport water to the well site through a temporary pipeline laid above ground on the state's right-of-way, an additional TxDOT permit is required. Permit applications are submitted to the respective TxDOT Area Office serving the county where the well is located. *NOTIFICATION The operator is REQUIRED to notify the district office when setting surface casing, intermediate casing, and production casing, or when plugging a dry hole. The district office MUST also be notified Witte operator intends to re-enter a plugged well or re -complete a well into a different regulatory field. Time requirements are given below. The drilling permit number MUST be given with such notifications. During Drilling Permit at Drilling Site. A copy of the Form W-1 Drilling Permit Application, the location plat, a copy of Statewide Rule 13 altemate surface casing setting depth approval from the district office, if applicable, and this drilling permit must be kept at the permitted well site throughout drilling operations. *Notification of Setting Casing. The operator MUST call in notification to the appropriate district office (phone number shown the on permit) a minimum of eight (8) hours prior to the setting of surface casing, intermediate casing, AND production casing. The individual giving notification MUST be able to advise the district office of the drilling permit number. Page 1 of 4 *Notification of Re-completion/Re-entry. The operator MUST call in notification to the appropriate district office (phone number shown on permit) a minimum of eight (8) hours prior to the initiation of drilling or re -completion operations. The individual giving notification MUST be able to advise the district office of the drilling permit number. Completion and Plugging Reports Hydraulic Fracture Stimulation using Diesel Fuel: Most operators in Texas do not use diesel fuel in hydraulic fracturing fluids. Section 322 of the Energy Policy Act of 2005 amended the Underground Injection Control (UIC) portion of the federal Safe Drinking Water Act (42 USC 300h(d)) to define "underground Injection" to EXCLUDE " ...the underground injection of fluids or propping agents (other than diesel fluel5) pursuant to hydraulic fracturing operations related to oil, gas, or geothermal production activities." (italic and underlining added.) Therefore, hydraulic fracturing may be subject to regulation under the federal UIC regulations if diesel fuel is injected or used as a propping agent. EPA defined "diesel fuel" using the following five (5) Chemical Abstract Service nutnbers: 68334-30-5 Primary Name: Fuels, diesel; 68476-34-6 Primary Name: Fuels, diesel, No. 2; 68476-30-2 Primary Name: Fuel oil No. 2; 68476-31-3 Primary Nmae: Fuel oil, No. 4; and 8008-20-6 Primary Name: Kerosene. As a result, an injection well permit would be required before performing hydraulic fracture stimulation using diesel fuel as defined by EPA on any well in Texas. Hydraulic fracture stimulation using diesel fuel as defined by EPA on a well in Texas without an injection well permit could result in enforcement action. Producing Well. Statewide Rule 16 states that the operator of a well shall file with the Commission the appropriate completion report within thirty (30) days after completion of the well or within ninety (90) days after the date on which the drilling operation is completed, whichever is earlier. Completion of the well in a field authorized by this permit voids the permit for all other fields included in the permit unless the operator indicates on the initial completion report that the well is to be a dual or multiple completion and promptly submits an application for multiple completion. All zones are required to be completed before the expiration date on the existing permit. Statewide Rule 40(d) requires that upon successful completion of a well in the same reservoir as any other well previously assigned the same acreage, proration plats and P -15s (if required) must be submitted with no double assignment of acreage. Dry or Noncommercial Hole. Statewide Rule 14(b)(2) prohibits suspension of operations on each dry or non-commercial well without plugging unless the hole is cased and the casing is cemented in compliance with Commission rules. If properly cased, Statewide Rule 14(b)(2) requires that plugging operations must begin within a period of one (I) year after drilling or operations have ceased. Plugging operations must proceed with due diligence until completed. An extension to the one-year plugging requirement may be granted under the provisions stated in Statewide Rule 14(b)(2). Intention to Plug. The operator must file a Form W -3A (Notice of Intention to Plug and Abandon) with the district office at least five (5) days prior to beginning plugging operations. If, however, a drilling rig is already at work on location and ready to begin plugging operations, the district director or the director's delegate may waive this requirement upon request, and verbally approve the proposed plugging procedures. *Notification of Plugging a Dry Hole. The operator MUST call in notification to the appropriate district office (phone number shown on permit) a minimum of four (4) hours prior to beginning plugging operations. The individual giving the notification MUST be able to advise the district office of the drilling perrnit number and all water protection depths for that location as stated in the Texas Commission on Environmental Quality letter. PI IONE (512) 463-6751 DIRECT INQUIRIES TO: DRILLING PERMIT SECTION, OIL AND GAS DIVISION Page 2 of 4 MAIL: PO Box 12967 Austin, Texas, 78711-2967 RAILROAD COMMISSION OF TEXAS OIL & GAS DIVISION PERMIT TO DRILL DEEPEN, PLUG BACK, OR RE-ENTER ON A REGULAR OR ADMINISTRATIVE EXCEPTION LOCATION PERMIT NUMBER 790944 DATE PERMIT ISSUED OR AMENDED Aug 06, 2014 DISTRICT * 03 API NUMBER 42-039-33219 FORM W -I RECEIVED Jul 03, 2014 COUNTY BRAZORIA TYPE OF OPERATION NEW DRILL WELLBORE PROFILE(S) Vertical ACRES 303.93 OPERATOR 215343 DENBURY ONSHORE, LLC 5320 LEGACY DRIVE PLANO, TX 75024-0000 NOTICE This permit and any allowable assigned may be revoked if payment for fee(s) submitted to the Commission is not honored. District Office Telephone No: (713) 869-5001 LEASE NAME HASTINGS COMMUNITY LEASE WELL NUMBER 1402R LOCATION 2 miles NE direction from PEARLAND TOTAL DEPTH 6400 Section. Block and/or Survey SECTION < 28 BLOCK { ABSTRACT < 551 SURVEY { HT&B RR CO/SMITH, G C DISTANCE TO SURVEY LINES 1664 ft. S 167 ft. W DISTANCE TO NEAREST LEASE LINE 199 ft. DISTANCE TO LEASE LINES 1261 ft. W 199 ft. S DISTANCE TO NEAREST WELL ON LEASE See FIELD(s) Below FIELD(s) and LIMITATIONS: * SEE FIELD DISTRICT FOR REPORTING PURPOSES ' FIELD NAME ACRES DEPTH WELL# DIST LEASE NAME NEAREST LEASE NEAREST WE HASTINGS, WEST 303.93 1 1402R 03 HASTINGS COMMUNITY LEASE 199 2036 RESTRICTIONS: This well cannot be produced concurrently from the same reservoir as: Pat O'Day #2 039-00286 THE FOLLOWING RESTRICTIONS APPLY TO ALL FIELDS This well shall be completed and produced in compliance with applicable special field or statewide spacing and density rules. If this well is to be used for brine mining, underground storage of liquid hydrocarbons in salt formations, or underground storage of gas in salt formations, a permit for that specific purpose must be obtained from Environmental Services prior to construction, including drilling, of the well in accordance with Statewide Rules 81, 95, and 97. This well cannot be produced concurrently from the same reservoir as: Pat O'Day #2 039.00286 This well must comply to the new SWR 3.13 requirements conceming the isolation of any potential flow zones and zones with corrosive formation fluids. See approved permit for those formations that have been identified for the county in which you are drilling the well in. Data Validation Time Stamp: Aug 6, 2014 9:53 AM( Current Version ) Page 3 of 4 RAILROAD COMMISSION OF TEXAS OIL & GAS DIVISION SWR #13 Formation Data BRAZORIA (039) County Formation Shallow Top Deep Top Remarks Geological Order Effective Date CAPROCK 580 590 disposal 1 12/17/2013 MIOCENE 1,750 6,220 disposal 2 12/17/2013 FRIO 2,000 4,200 disposal 3 12/17/2013 HET LIME 4,400 4,400 disposal 4 12/17/2013 OLIGOCENE 5,760 5,760 disposal 5 12/17/2013 OTIS 7,810 7,810 disposal 6 12/17/2013 This is a dynamic table that will be updated continuously. It is the operators responsibility to make sure that at time of spudding the well the most current table is being referenced. EXHIBIT «G,) SURVEY OF PUBLIC ROAD IMPACT rEAFVHCON Environmental Challenges BUSINESS SOLUTIONS March 2, 2015 Honorable Mayor Tom Reid City of Pearland City Hall 3519 Liberty Drive Pearland. Texas 77581 EarthCon Consultants, Inc. 14405 Walters Road Suite 700 Houston Texas 77014 RE: Report of Potential Impact to City of Pearland Public Roads and Streets City of Pearland, Texas Code of Ordinances Hastings Community Lease Well HCL 1402R Denbury Resources, Inc. EarthCon Project No. 02.20150066.00 Dear Mayor Reid: P. 281-240-5200 F• 866-263-0098 www.earthcon.com This report provides the information and conclusions necessary to determine the impact of Denbury Resources. Inc (Denbury) planned construction of the Hastings Community Lease Well HCL 1402R (development) on the public roads and streets in the City of Pearland. Texas. This report is required as part of the City of Pearland, Texas Code of Ordinances. EarthCon Consultants, Inc. (EarthCon) has prepared this report to fulfill that requirement. A site visit was performed on February 24, 2015 by Mr. Andy Shook, P.E., Senior Engineer to obtain specific site and vicinity information for this report. INTRODUCTION The proposed development area is located approximately 1.100 feet west of the intersection of Texas State Highway 35 (SH35) and County Road 126 (CR126), also known as Dixie Farm Road, within the City of Pearland, Texas. SH35 is a State of Texas Department of Transportation (TxDOT) maintained roadway. Figure 1 presents a Site Location Map and is included in Attachment 1 The development is located west of SH35 and is accessed by a gravel road that crosses a drainage ditch parallel to SH35. A 24 -inch diameter drainage culvert extends underneath the access road parallel to SH35 (see Figure 2 in Attachment 1). The proposed well will be located about 1,100 feet west of SH35 (see Figure 3 in Attachment 1). Copyright c 2015 EarthCon Consultants. Inc All Rights Reserved 2IPage The development area is approximately 300 foot by 300 foot in plan dimensions (see Figure 4 in Attachment 1). There have been no previous known industrial activities within this development area The planned activities consist of installing one oil producing well (Well HCL 1402R) within the development. The development area is relatively level with drainage generally to the east toward the SH35 drainage ditch This development is part of an Enhanced Oil Recovery (EOR) project in which water and CO2 are injected (flooded) into a reservoir to increase production by reducing oil viscosity and increasing the flow of oil to adjacent recovery wells. The operation of this EOR system will require water or CO2 injection at high pressure from other wells in the area into the oil-bearing formation, recovery of oil at the 1402R, and transport of the recovered oil via pipeline to an offsite recovery facility. This development will include operation and maintenance of the oil well and construction of appurtenances on the well head for production. This system has been used successfully in this and other areas of the country to improve recovery of oil. thus limiting the United States of America dependence on foreign product. INSTALLATION The actual installation and construction of this development will utilize the same basic processes typical of oil field production wells in this area. Typical equipment and supplies used include a work over rig, drill pipe, steel mud pits, container box storage structures, steel well casing. drilling mud, bulk cement, portable office building and other similar equipment. This equipment and supplies are usually mobilized to the site on tractor -trailers or, in some cases, the equipment may be truck mounted. The well drilling and completion operations typically require several months to complete. Traffic consists of labor and supplies after the initial mobilization and completion. Activities associated with well installation and completion will be in accordance with the requirements of the Railroad Commission of Texas (RRC) and the Texas Oil and Gas Code. OPERATIONS Once the development is operational, the traffic on surrounding roadways and streets will generally be limited to small support trucks, pickup trucks or passenger vehicles. The pipeline bringing the water onsite will provide the driving force to recover oil from adjacent wells. The oil from these wells will be transported via pipeline to an offsite facility. Occasional repairs may require the use of workover rigs and other mobile equipment. The workover rigs are usually *EA IST HC 14405 onaconrssultantsRoad,Inc. 14405 Wlte P. 281-240-5200 Enwa�ne+xaiCha%egos Suite 700 F. 866-263-0098 Enwc". e" a!Ch SOLUTIONS Houston, Texas 77014 www.earthcon.com Report of Potential Impact to City of Pearland Public Roads and Streets Hastings Community Lease Well HCL 1402R Page 13 •EAPTHCON' ErrnrormeritaI Cha$enges BUSINESS SOLUTIONS truck mounted. Other equipment will typically be brought onsite by tractor -trailers or smaller trucks. ASSESSMENT The equipment and materials brought onsite will all follow a route that will be on state highways. The equipment and materials will all enter the site from the access road located on the west side of SH35. approximately 100 feet south of the intersection of SH35 and CR126. There is sufficient distance between the development and SH35 to allow for temporary staging of the required number of vehicles to support the project, without blocking public roads. CONCLUSION All major activity on streets and roads associated with this development will occur on SH35. No adverse effect to City of Pearland public roads and streets is anticipated. Any damage to SH35 or the culvert below the access road will be repaired in consultation with TxDOT. We appreciate the opportunity to submit this report. If you have any questions, please feel free to call Gary R. Horwitch, P.E. at (281) 240-5200, extension 2716, or Andy Shook. P.E. at (281) 240-5200, extension 2723. Sincerely, EARTHCON CONSULTANTS, INC. Firm No. 7572 W. A. Shook, P.E. Senior Engineer Texas P.E. No. 79335 03J - Gary R. Horwitch, P.E. Principal EngineerNice President Texas P.E. No. 48456 Project #: 02.20150066.00 March 2, 2015 Copyright © 2015 EarthCon Consultants. Inc All Rights Reserved EarthCon Consultants, Inc. 14405 Walters Road Suite 700 Houston. Texas 77014 P. 281-240-5200 F. 866-263 0098 www.earthcon.com Environmental Challenges BUSINESS SOLUTIONS ATTACHMENT 1 FIGURES Project # 02 20150066 00 March 2, 2015 Copyright © 2015 EarthCon Consultants. Inc All Rights Reserved EarthCon Consultants. Inc. 14405 Walters Road Suite 700 Houston. Texas 77014 P: 281-240-5200 F. 866-263-0098 vnvw.earthcon.com Environmental Challenges BUSINESS SOLUTIONS aF LEGEND in City Limits 7sw . . wow NI Jew MMrcM DENBURY ONSHORE. LLC. Proposed Well Location Hastings Community Lease Unit No. 1402R Brazona County. Texas 0 PROD NO 02 20+5026600 SCALE FEET 2500 5000 rEA�THCON' EarthCon Consultants Inc. 14405 Watters Rd, Suite 700 Houston, Tx 77014 Firm 7572 DRAWN JAtT Source: City of Pearland Aerial Imagery 2012. SITE LOCATION MAP CHECKED AS DATE 02Y20t5 1 Copytigtt 0 201S EarthCon Consultants. Inc Al Rynts Reserved DEVELOPMENT ler AMA • M.....,e F {� CUL VFP I e',A.A C*:..e.w SCNE FEE l 0 150 300® Source Goo0eEarth 2014 OF. NEWRY ONSHORE LLC a,opwetl W*E Location Haln01 Communes Lease UM No 1407N Nuaza a County. Texas •EAPTHCON' EarthCon Consultants Inc. i1Yr Nov, n1 Sur :T if, :5': ENTRNICE LOCATION WEI ZYCHLINSKI SUBDIVISION VOLUME 29, PAGE 9, a DEVELOPMENT B.C.M.R. ALEXANDER JO FAMILY LIMITED PARTNE IP — PROPERTY ID # 168 '4 o D- ct w a 3 0 O'DAY PAT MRS ESTATE CL a PROPERTY ID # 168409 VOL 205 PG 398 B.C.D.R ROP° ALEXANDER JOHN FAMILY LIMITED PARTNERSHIP PROPERTY ID # 178192 300' LOT 181 185 0 N am In PAGIE RODMAN ET AL PROPERTY ID # 559720 z ao LOT 186 0\.c) LOT 180 H.T.&B. RR SECTION 27 A— 308 G.C. SMITH SECTION 28 A-551 AKA N.T.&B. RR SECTION 28 INDUSTRIAL Cowart 1111 SITE Pmt` t, HASTINGS FIELD ROAD \AMITY NAP NTS. ALEXANDER JOHN FAMILY LIMITED PARTNERSHIP PROPERTY ID # 178199 RAVEL ROAD O'DAY PAT EST LINDA PROPERTY ID # 178239 VOL 205 PG 398 B.C.D.R. LOT 187 MARIO ALBERTO OCHOA PEREZ Property ID # 178235 Source Denbury Onshore, LLC SCALE FEE 1 150 300 DENBURY ONSHORE LLC Proposed Well Location Hastings Community Lease Unit No 1402R Brazona County Texas PROD NO 02 2015006000 .EA IV HCON EarthCon Consultants Inc PLAN OFFSET :M r•I AS 1DATE 02/201511 3 DEVELOPMEN yr. 1fASTINGS COMMUNITY ASE LINE Source: Denbury Onshore, LLC SCALE FEET 0 50 100 DENBURY ONSHORE, LLC Proposed Well Location Hastings Community Lease Unit No 1402R Brazona County Texas PROD NO 02:01300E600 1DEAfVHCON EarthCon Consultants Inc. '4405 Walters Rd, &,4e 700 Housbn, Tx 77014 Fin 7572 PLAN DIMENSIONS AS wrc 01!2015 EXHIBIT «H» ENVIRONMENTAL REPORT v•EAI�THCON" Environmental Challenges BUSINESS SOLUTIONS March 2, 2015 Honorable Mayor Tom Reid City of Pearland City Hall 3519 Liberty Drive Pearland, Texas 77581 EarthCon Consultants, Inc. 14405 Walters Road Suite 700 Houston, Texas 77014 P: 281-240-5200 F• 866-263-0098 www.earthcon.com RE: Report of Potential Damage to Land, Air, Water and Animals Due to Operations City of Pearland, Texas Code of Ordinances Hastings Community Lease Well HCL 1402R Denbury Resources, Inc. EarthCon Project No. 02.20150066.00 Dear Mayor Reid This report provides the information and conclusions necessary to determine possible environmental damage to the land. air. water and animals from the Denbury Resources. Inc. (Denbury) planned construction of Hastings Community Lease Well HCL 1402R (development) in the City of Pearland, Texas. This report is required as part of the City of Pearland, Texas Code of Ordinances. EarthCon Consultants, Inc. (EarthCon) has prepared this report to fulfill that requirement. A site visit was performed on February 24. 2015 by Mr. Andy Shook, P.E., Senior Engineer, to obtain specific site and vicinity information for this report. INTRODUCTION The proposed development area is located approximately 1,100 feet west of the intersection of Texas State Highway 35 (SH35) and County Road 126 (CR126), also known as Dixie Farm Road, within the City of Pearland, Texas. SH35 is a State of Texas Department of Transportation (TxDOT) maintained roadway. Figure 1 presents a Site Location Map and is included in Attachment 1. The development is located west of SH35 and is accessed by a gravel road that crosses a drainage ditch parallel to SH35. A 24 -inch diameter drainage culvert extends underneath the access road parallel to SH35 (see Figure 2 in Attachment 1). The proposed well will be located about 1.100 feet west of SH35 (see Figure 3 in Attachment 1). The development area is approximately 300 foot by 300 foot in plan dimensions (see Figure 4 in Attachment 1). Copynght © 2015 EarthCon Consultants Inc All Rights Reserved 2IPage There have been no previous known Industrial activities within this development area. The planned activities consist of installing one oil producing well (Well HCL 1402R) within the development. The development area is relatively level with drainage generally to the east toward the SH35 drainage ditch This development is part of an Enhanced Oil Recovery (EOR) project in which water and CO2 are injected (flooded) into a reservoir to increase production by reducing oil viscosity and increasing the flow of oil to adjacent recovery wells. The operation of this EOR system will require water or CO2 injection at high pressure from other wells in the area into the oil-bearing formation, recovery of oil at the 1402R, and transport of the recovered oil via pipeline to an offsite recovery facility. This development will include operation and maintenance of the oil well and construction of appurtenances on the well head for production. This system has been used successfully in this and other areas of the country to improve recovery of oil. thus limiting the United States of America dependence on foreign product INSTALLATION The actual installation and construction of this development will utilize the same basic processes typical of oil field wells in this area. Typical equipment and supplies used include drilling rigs, drill pipe, steel mud pits, container box storage structures, steel well casing, drilling mud. bulk cement. portable office building and other similar equipment. This equipment and supplies are usually mobilized to the site on tractor -trailers or, in some cases, the equipment may be truck mounted. The well drilling and completion operations usually require several months to complete. Traffic consists of labor and supplies after the initial mobilization and completion Activities associated with well installation and completion will be in accordance with the requirements of the Railroad Commission of Texas (RRC) and the Texas Oil and Gas Code_ OPERATIONS Once the development is operational. the traffic on surrounding roadways and streets will generally be limited to small support trucks. pickup trucks or passenger vehicles The pipeline bringing the water onsite will provide the driving force to recover oil from adjacent wells. The oil from these wells will be transported via pipeline to an offsite facility. Occasional repairs may require the use of workover rigs and other mobile equipment The workover rigs are usually truck mounted. Other equipment will typically be brought onsite by tractor -trailers or smaller trucks .EAIRTHCON- Enworfnerta! Cna'engcs BUSINESS SOLUTIONS EarthCon Consultants, Inc. 14405 Walters Roac Suite 700 Houston, Texas 77014 P 28' -240-520C F 866-263-0098 www.earthcon.com Report of Potential Damage to Land. Air. Water and Animals Due to Operations Hastings Community Lease Well HCL 1402R Page 13 ASSESSMENT •EAPTHCON' Emnrorvnental Challenges BUSINESS SOLUTIONS Possible environmental damage to the land, air, water and animals from the EOR system could potentially come from a leak of water from the high pressure pipeline onsite or at the wellhead. A leak of water or oil will usually be indicated by the following: • Dead or discolored vegetation amid healthy plants: • An unusual hissing or roaring sound: • Strange or unusual odor near the pipeline: • A pool of liquid on the ground near the pipeline: and • Fire or explosion. As a means to limit the potential of a leak occurring. and to limit the impact if a leak should occur, remote monitoring of valves and pressures provides the capability to operate automated valves to shutdown and/or isolate sections of the pipeline systems, if necessary. In addition, Denbury personnel will be making routine daily rounds to monitor the well's performance If a leak of water occurs. the potential damage to the land. air and water will be minimal. as water will have only a small impact area. Potential damage to animals will also be limited, as the noise associated with the water leak will chase animals away from the area. If an oil leak from adjacent wells occurs, the potential for damage to land and water is more likely, but still considered minimal. The impact will be minimized by remote monitoring of the oil recovery system and pipeline. As soon as an oil leak is discovered, the Denbury Emergency Response Plan will be implemented which includes notifying local, state and federal emergency response agencies. The necessary equipment and personnel will be mobilized to repair the damage. clean up the oil spill. and remediate the area as required by the RRC and the Texas Oil and Gas Code. The cost for remediating a spill is dependent on the quantity of oil spilled. the duration the leak has to soak into the soil, and if any water is impacted. The scenario in the cost estimate would occur with an oil leak from one of the adjacent recovery wells with a quantity of oil sufficient to flow from the leak to the south and east. The leak is assumed to cause an impact to both onsite and offsite soil. as well as impacting standing water in the drainage ditch along SH35. The estimated cost to remediate a routine (or larger) spill or leak would likely be on the order of $25.000 to $100.000. The major equipment required for remediation includes a vacuum truck, a backhoe/excavator. and dump trucks. CONCLUSION Safety of the public and company personnel is Denbury's highest priority. In the unlikely event of a leak or incident, Denbury will immediately initiate their Emergency Response Plan to quickly Project 0: 02.20150066 00 March 2. 2015 Copyright © 2015 EarthCon Consultants. Inc. Ali Rights Reserved EarthCon Consultants. Inc. 14405 Walters Road Suite 700 Houston, Texas 77014 P. 281-240-5200 F 866-263-0098 www.earthcon com Environmental Challenges BUSINESS SOLUTIONS ,f Report of Potential Damage to Land, Air, Water and Animals Due to Operations Hastings Community Lease Well HCL 1402R Page 14 •EAEkTHCON' Environmental Challenges BUSINESS SOLUTIONS control the situation and notify the City of Pearland and state and federal emergency response agencies. We appreciate the opportunity to submit this report. If you have any questions, please feel free to call Gary R. Horwitch, P.E. at (281) 240-5200. extension 2716 or Andy Shook. P.E. at (281) 240-5200, extension 2723. Sincerely, EARTHCON CONSULTANTS, INC. Firm No. 7572 W. A. Shook, P.E. Senior Engineer Texas P.E. No. 79335 D3J- Gary R. Horwitch, P.E. Principal EngineerNice President Texas P.E. No 48456 Project # 02.20150066.00 March 2. 2015 Copyright © 2015 EarthCon Consultants. Inc All Rights Reserved EarthCon Consultants. Inc. 14405 Walters Road Suite 700 Houston, Texas 77014 P: 281-240-5200 F: 866-263-0098 www.earthcon.com Environmental Challenges BUSINESS SOLUrioNS N' ATTACHMENT 1 FIGURES Project * 02.20150066 00 March 2, 2015 Copyright © 2015 EarthCon Consultants. Inc All Rights Reserved EarthCon Consultants. Inc. 14405 Walters Road Suite 700 Houston. Texas 77014 P: 281-240-5200 F: 866-263-0098 www.earthcon.com Environmental Chal/onges BUSINESS SOLUTIONS c4, LEGEND ei City Limits DENBURY ONSHORE, LLC Proposed Well Location Hastings Community Lease Unit No. 1402R Brazoria County. Texas 0 FRO. N0.022015030000 SCALE FEET 2500 5000 10EAE�THCON° EarthCon Consultants Inc. 14405 Walters Rd, Suite 700 Houston, To 77014 Firm 7572 Source: City of Pearland Aerial Imagery 2012 SITE LOCATION MAP CRANK JMT I(EMKE0 I DATE 0212015/ 1 AS Copyrght 2015 EarnCon Consultants, Inc All Rights Re served Imo FEATumi D 100 ADD Sarco Geo0 Env, 2014 OFNRURY ONSHORE. LLC P oposo0 WN LOC200f1 Hastings Comnwry Lrase Uot No 1402R &axons County. Teras IIPLAIkFHLON EarthCon Consultants Inc. I410$ M's4F RE. Sub 1O Ibuihn 1. P01a Fen 1$77 ENTRANCE LOCAI ION ' As 1a.' cooa,1 ngyyna 71'4 Fent. Ars 4'wM 0 N as r Q20o w wa Q� LOT 181 185 0 N Q0) u-) z ZYCHUNSKI SUBDIVISION VOLUME 29, PAGE 9, DEVELOPMENT B.C.M.R. ALEXANDER JOHN FAMILY LIMITED PARTNERSHIP PROPERTY ID # 178199 ALEXANDER JO FAMILY LIMITED PARTNE IP PROPERTY ID # 168 ALEXANDER JOHN FAMILY LIMITED PARTNERSHIP PROPERTY ID # 178192 CT O'DAY PAT MRS ESTATE PROPERTY ID # 168409 VOL 205 PG 398 B.C.D.R. ROPD LOT 186 PAGIE RODMAN ET AL PROPERTY ID # 559720 RAVEL ROAD 0.9 LOT 180 H.T.&B. RR SECTION 27 A-308 G.C. SMITH SECTION 28 A-551 A KA H.T.&B. RR SECTION 28 O'DAY PAT EST LINDA PROPERTY ID # 178239 VOL 205 PG 398 B.C.D.R. LOT 187 MARIO ALBERTO OCHOA PEREZ Property ID # 178235 F. Source: Denbury Onshore, LLC. SCALE FEET 0 150 300 DENBURY ONSHORE. LLC. Proposed Well Location Hastings Community Lease Unit No. 1402R Brazoria County, Texas PROJ NO 0220, 50030 00 IspEAFVHCON° EarthCon Consultants Inc. 14405 Walters Rd, Suite 700 Housbn, Tx 77014 Firm 7572 PLAN OFFSET DRAWN ONE G ED AS !DATE 0212015] FIE 3 ;i; riASTINGS COMMUNITY la-lEASE LINE 1 1 Source Danbury Onshore, LLC. SCALE FEET 0 50 100 DENBURY ONSHORE. LLC Proposed Well Location Hastings Community Lease Unit No. 1402R Brazona County. Texas POOJ NO D220,5000000 rEAFTHCON EarthCon Consultants Inc. 14405 Waiters Rd, Sate 700 Houston, Tx 77014 Fum 7572 PLAN DIMENSIONS Oram+ JMT CFECxEO AS DAM 02/2015 Residency Affidavit Sworn Statement for Parents — Residency Affidavit Packet A 1 of 4 (To be completed by Parent/Guardian residing with resident on mortgage or lease) CLEAR CREEK INDEPENDENT SCHOOL DISTRICT Parent/Guardians, who are currently residing with persons having a legal residence within the boundaries of the Clear Creek Independent School District and whose child(ren) will attend the district's schools, are required to declare the circumstances which make this arrangement necessary. They will be further required to declare that no false information has been provided to CCISD concerning their current residency status. 1, , do hereby declare that my family will be (Parent/Guardian of each Student) residing in the home of: Resident's Name: Relationship: Address: Street address City Zip Resident's Primary Telephone: Alternate Telephone: Parent/Guardian Primary Telephone: Alternate Telephone: Parent/Guardian e-mail address: Previous address and telephone: Reasons for moving in: Does your child currently, or plan to participate in extra -curricular activities such as athletics and fine arts? Yes No If Yes, please describe: Length of time planning to be at this residence: Name of student Age Grade School Year *Please note: Only one student per original affidavit. FALSIFICATION OF INFORMATION ACKNOWLEDGEMENT I declare that I have provided no false information to the Clear Creek Independent School District (CCISD) regarding my family residency. I understand that falsifying this sworn affidavit is a criminal offense (Perjury) under Section 37.01 of the Texas Penal Code, which is a Class A misdemeanor punishable up to one (1) year of confinement in jail; a fine not to exceed $2,000.00; or both such fine and imprisonment. Another criminal offense for falsifying this residency information is a violation of Texas Penal Code 37.10: Tampering with a Government record. Parent Residency Affidavit Packet A 2 of 4 Further, such person is liable to the district for the period during which the ineligible student is enrolled, for the greater of: 1) the maximum tuition fee allowed under Section 25.038 of the Texas Education Code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses. The regular tuition rate is $42.00 per school day for 2015-2016 school year. I understand that this child will be administratively withdrawn from CCISD if it is determined that I have enrolled the child based on false information. I also understand that CCISD reserves the right to investigate claims of residence under the CCISD administrative guidelines as permitted by the Texas Education Code and may conduct a home visit to verify actual occupancy. Parcnt/Guardian's signature Date STATE OF COUNTY OF BEFORE ME, the undersigned authority, on this day personally appeared , known to me by (Parent signing form) (ID, Passport,etc) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she executed that same for the purposed and consideration therein expressed. GIVEN UNDER MY HAND, and seal of this office this day of , 20 A.D. Notary Public, State of Notary Seal Here 30 DAY DEADLINE My commission expires: Parent / Notarized Residency Affidavit Sworn Statement for Resident — Residency Affidavit (To be completed by resident on Mortgage/Lease of property) CLEAR CREEK INDEPENDENT SCHOOL DISTRICT Packet A 3 of 4 Residents living within the boundaries of the Clear Creek Independent School District who provide shelter for anyone who will be attending school in the Clear Creek Independent School District, other than immediate family members, are required to sign the following statement declaring that no false information has been provided to the district and to provide the district with verification of residence. Required proof of residency includes the following: • a deed or current lease agreement • a utility bill (Gas, Water, or Electric) reflecting resident's name and the service address a current Texas driver's license/Texas ID with correct address. 1, , do hereby declare that the Resident Below listed person(s) are currently residing in my home at: Address City Zip Names of the person's that have moved in with you in regards to this affidavit: Resident's Primary Telephone Number: Resident's Alternative Telephone Number: FALSIFICATION OF INFORMATION ACKNOWLEDGEMENT I declare that I have provided no false information to the Clear Creek Independent School District (CCISD) regarding my family residency. I understand that falsifying this sworn affidavit is a criminal offense (Perjury) under Section 37.01 of the Texas Penal Code, which is a Class A misdemeanor punishable up to one (1) year of confinement in jail; a fine not to exceed $2000.00; or both such fine and imprisonment. Another criminal offense for falsifying this residency information is a violation of Texas Penal Code 37.10: Tampering with a Government record. Further, such person is liable to the district for the period during which the ineligible student is enrolled, for the greater of: 1) the maximum tuition fee allowed under Section 25.038 of the Texas Education Code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses. The regular tuition rate is $42.00 per school day for 2015-2016 school year. Homeowner Residency Affidavit Packet A 4 of 4 Attach a copy of the following four items to the affidavit: • Parent's Driver's License • Resident's Texas Driver's License or Photo I.D. • Current Utility Bill (Gas, Water, or Electric- Disconnect notices will not be accepted) • Current Lease or Mortgage statement The completed original affidavit including all attachments and a copy of the original affidavit including all attachments must be returned to the Facility Services Department located in the Education Support Center at 2425 East Main Street in League City, Texas for approval. Please Note: No copies or notary services are available at this location. I understand that the child residing with me on condition of this affidavit will be withdrawn from CCISD if I have provided false testimony for this child. I also understand that CCISD reserves the right to investigate claims of residence under CCISD administrative guidelines. Resident's signature Date STATE OF COUNTY OF BEFORE ME, the undersigned authority, on this day personally appeared , known to me by (Resident signing form) (ID, Passport,etc) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she executed that same for the purposed and consideration therein expressed. GIVEN UNDER MY HAND, and seal of this office this day of , 20 A.D. Notary Public, State of Notary Seal Here My commission expires: Homeowner/Notarized