Fill and Sign the Using Existing Well Bore to Dispose of Water from Wells on Lessors Lands Form

Page 1 of 3 SALT WATER DISPOSAL LEASE (Using Existing Well Bore to Dispose of Water from Wells on Lessor’s Lands) STATE: COUNTY: LESSOR: (Name and Address) LESSEE: (Name and Address) EFFECTIVE DATE: For adequate consideration, Lessor, named above, grants to Lessee, named above, and its successors and assigns, the specific rights described below regarding the use of portions of the following land located in the county and state named above (the “Land”): (Description of Land) The rights granted by Lessor to Lessee are as follows: 1. Lessee is granted the right to make use of the (Name of Existing Well) well bore (the “Well”) located _____ feet from the _____ line and _____ feet from the _____ line of (Description of Land on which Well is Located), and Lessor leases and lets to Lessee (Amount of Area) of the surface immediately surrounding the Well, for Lessee's use in and for the disposa l of salt water and other fluids produced by lease operations from and on all lands presently owned by Lessor in the county and state named above. Additionally, Lessee is granted the right t o construct, maintain, and operate all equipment and facilities required for the disposa l of salt water and other fluids on the _____ acres immediately surrounding the well. 2. Lessor leases and lets to Lessee the surface of sufficient lands necessary for the l ocation of salt water gathering or accumulation tanks, pump stations and other necessary equipment and structures, on other parts of Lessor's Land, all in connection with a salt water disposal system which Lessee is authorized to construct and operate under the terms of this Lease. 3. Lessee is granted the right to construct and maintain one or more pipelines for the transportation of salt water and other fluids from adjoining lands onto the Land to the gathering or accumulation tanks and from the gathering or accumulation tanks to the Well. L essee is granted all easements and rights-of-way as may be reasonably required for the maintenance and operation of the Well and salt water disposal system installed by Lessee. Lessor rese rves the right to approve the location of all pipelines. This approval shall not be unreasonably withheld. 4. This Lease and the rights granted shall extend to Lessee and are for the benefit of Lessee, its successors and assigns, for a term of _____ years (the “Primary Term”) from the Effective Date stated above and: (a) for as long as the rights granted shall be continuously exercise d without cessation of more than _____; or, (b) until such time as the Lessee shall either delivered Page 2 of 3 to Lessor, or filed for record in the office of the clerk of the county named above, a release of this Lease. Lessee, its successors and assigns, shall have the right to remove all propert y and equipment placed on the Land within a reasonable time after the expiration or release of this Lease. 5. Lessee shall pay Lessor the sum of $_____ on the last day of the first month in which Lessee commences the use of the Well, and that amount on the last day of ea ch following month, for as long as salt water or other fluids from one well is injected into Well. Lesse e shall pay Lessor the additional sum of $_____ per month, payable on the last day of the month, for each well, in addition to the first well, connected to the salt water disposal system. 6. Lessee shall pay Lessor reasonable amounts for damage or injury to the surface of the Land or to Lessor's personal property or livestock, and shall, upon the execution of this Lease, make a one-time payment of $_____ to Lessor for the tank battery site adjacent to the Well and as full payment for any damages to the _____ acres of surface around the Well. 7. Lessee shall not truck water to the salt water disposal system on the Land wit hout first receiving Lessor's written permission. 8. If Lessee ceases to operate the salt water disposal system installed and locat ed on the Land, Lessor shall have the right to approve any successor operator, which approval shall not be unreasonably withheld. 9. Lessee may not assign this Lease in whole or in part unless Lessee first obtains Lessor's written consent, which consent shall not be unreasonably withheld. 10. This Lease shall not extend the primary term of the oil and gas lease prese ntly owned by the Lessee on the Land. 11. Lessee shall comply with all rules and regulations of any governmental agencies in carrying out its operations under this Lease on the Land. 12. All payments accruing to the Lessor shall be made by United States Mail, postage prepaid, addressed to Lessor at the address provided above. 13. Lessee agrees to indemnify and hold Lessor harmless from and against any claims or causes of action of any nature which may be brought or asserted as a result of Lessee's operat ions under this Lease. This Lease and the rights and obligations created by it shall extend to and be bindi ng on the respective heirs, successors, assigns, and representatives of Lessor and Lessee. This Lease is signed by Lessor and Lessee as of the date of acknowledgment of their signatures below, but shall be effective for all purposes as of the Effective Date stated above. Lessor Page 3 of 3 Lessee (Acknowledgments)