Instructions
Each form is available in two formats:
- Adobe Acrobat® .pdf files which can be viewed and printed. Additionally, as we continue to update our forms, newer versions will be able to be filled in directly from Adobe Acrobat®.
- Microsoft Word® .doc. files which can be completed on the screen.
You may save the forms to your computer, however it is advisable to periodically download the forms from this website to ensure that you are using the most current form. This will reduce the likelihood for unnecessary delays in processing your submittal.
If you have any difficulty using any of the forms downloaded from our website, please contact Jamie Adams at 317-232-1098 or by email at jadams@dnr.IN.gov for assistance.
Forms
- Abandonment Certification Report Form 54873 (fillable PDF)
- Abandonment Certification Report Form 54873 (fillable Word)
- Annual Production Report Form 56442 (fillable PDF)
- Annual Production Report Form 56442 (fillable Word)
- Application for Alternate Plugging Method or Material (fillable PDF)
- Application for Alternate Plugging Method or Material (fillable Word)
- Application for Assumption of Responsibility (fillable PDF)
- Application for Assumption of Responsibility (fillable Word)
- Application for Coal Bed Methane Well Permit Form 54785 (fillable PDF)
- Application for Coal Bed Methane Well Permit Form 54785 (fillable Word)
- Application for Fluid Storage Facility Form 56444 (fillable PDF)
- Application for Fluid Storage Facility Form 56444 (fillable Word)
- Application for Permit Transfer form 20224 (fillable PDF)
- Application for Permit Transfer form 20224 (fillable Word)
- Application for Petroleum Exploration or Production Activities on State Lands (fillable PDF)
- Application to Remediate Contaminated Soils at Location Other than Spill Site (fillable PDF)
- Application for Storage Facility Registration Transfer (fillable PDF)
- Application for Storage Facility Registration Transfer (fillable Word)
- Application for Temporary Abandonment or Plugging Deferral Permit (fillable PDF)
- Application for Test Hole Permit form 55076 (fillable PDF)
- Application for Test Hole Permit form 55076 (fillable Word)
- Application for Well Permit Form 21096 (fillable PDF)
- Application for Well Permit Form 21096 (fillable Word)
- Application for Well Testing Agreement (fillable PDF)
- Application for Well Testing Agreement (fillable Word)
- Application to Land Farm Water Based Drilling and Completion Wastes Form 56443 (fillable PDF)
- Application to Modify A Class II Well Permit 55116 (fillable PDF)
- Application to Modify A Class II Well Permit 55116 (fillable Word)
- Application to Oil Lease or County Roads Form 56446 (fillable PDF)
- Application to Oil Lease or County Roads Form 56446 (fillable Word)
- Application to Register an Existing Non-Commercial Gas Well Form 56441 (fillable PDF)
- Blanket Surety Bond Form 12494 (fillable PDF)
- Blanket Surety Bond Form 12494 (fillable Word)
- Bond Acknowledgment (fillable PDF)
- Bond Acknowledgement (fillable Word)
- Coal Owner Consent (CBM) Form 54784 (For Use When Coal is Not Leased) (fillable PDF)
- Coal Owner Consent Form 54405 (fillable PDF)
- Coal Owner Consent Form 54405 (fillable Word)
- Corrective Action Plan (fillable PDF)
- Corrective Action Plan (fillable Word)
- County Test Hole Bond (fillable PDF)
- County Test Hole Bond (fillable Word)
- County Test Hole Completion Report Form 55070 (fillable PDF)
- County Test Hole Completion Report Form 55070 (fillable Word)
- Facility Failure and Release Report form 55504 (fillable PDF)
- Facility Failure and Release Report form 55504 (fillable Word)
- Final Report of Land Farming of Water Based Drilling and Completion Wastes Form 56473 (fillable PDF)
- Fluid Level/Pressure Test Report Form 56436 (Fillable PDF)
- Fluid Level/Pressure Test Report Form 56436 (Fillable Word)
- Hydraulic Fracturing Report for all Wells Except Coal Bed Methane Form 54965 (fillable PDF)
- Individual Test Hole Bond (fillable PDF)
- Individual Test Hole Bond (fillable Word)
- Individual Test Hole Completion Report Form 54701 (fillable PDF)
- Individual Test Hole Completion Report Form 54701 (fillable Word)
- Operators Concrete Fluid Storage Structure Abandonment Report Form 56439 (fillable PDF)
- Operators Fluid Storage Pit Abandonment Report Form 56440 (fillable PDF)
- Operators Fluid Storage Pit Abandonment Report Form 56440 (fillable Word)
- Operator's Well Plugging Report Form 54874 (fillable PDF)
- Operator's Well Plugging Report Form 54874 (fillable Word)
- Organizational Report (fillable PDF)
- Organizational Report (fillable Word)
- Personal Surety Bond Form 56454 (fillable PDF)
- Personal Surety Bond Form 56454 (fillable Word)
- Public Notice Certification for Non-Commercial Gas wells 56498 (fillable PDF)
- Public Notice Certification for Non-Commercial Gas wells 56498 (fillable Word)
- Public Notice Certification for Class II Wells 56499 (fillable PDF)
- Public Notice Certification for Class II Wells 56499 (fillable Word)
- Quarterly Monitoring Report Form 56435 (fillable PDF)
- Quarterly Monitoring Report Form 56435 (fillable Word)
- Storm Water Discharge Certification Affidavit Form 56438 (fillable PDF)
- Storm Water Discharge Certification Affidavit Form 56438 (fillable Word)
- Surety Bond Form 36038 (fillable PDF)
- Surety Bond Form 36038 (fillable Word)
- Verification of Certificate of Deposit Form 17596 (fillable PDF)
- Verification of Certificate of Deposit Form 17596 (fillable Word)
- Verification of Coal Seam Protection Report Form 54783 (fillable PDF)
- Verification of Coal Seam Protection Report Form 54783 (fillable Word)
- Well Completion/Re-Completion Report Form 55079 (fillable PDF)
- Well Completion/Re-Completion Report Form 55079 (fillable Word)
- Well Plugging Plan Form 54872 (fillable PDF)
- Well Plugging Plan Form 54872 (fillable Excel)
- Well Rework Report Form 55069 (fillable PDF)
- Well Rework Report Form 55069 (fillable Word)
- Well Stimulation and Hydraulic Fracturing Report Form 54892 (fillable PDF)
- Well Stimulation and Hydraulic Fracturing Report Form 54892 (fillable Word)
- Well Stimulation Plan Form 54893 (fillable PDF)
- Well Stimulation Plan Form 54893 (fillable Word)