Owner Address Change Form

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Mewbourne Oil Company
P.O. Box 7698
Tyler, TX 75711
ATTN: Division Order Department
Fax: 903-561-8909
Owner Address Change Form
Please fill out the attached form and fax or mail to Attn: Division Order Dept.
For your protection, address changes will not be accepted by telephone.
Tax Identification or Social Security Number MUST be provided for verification purposes.
Date: ____________________
Name On Account: _______________________________________________
Owner Number: ________________
New Address:
____________________________________________________
____________________________________________________
Old Address:
____________________________________________________
____________________________________________________
Daytime Phone Number (Including Area Code): ____________________________
Tax Identification or Social Security Number: ______________________________
Signature of Owner(s) or Authorized Representative:________________________________________
(Please provide POA or authorized documents if signing on owner’s behalf)
NOTE: THIS DOCUMENT IS ONLY FOR CHANGES TO EXISTING INTEREST OWNERS.
(PLEASE CALL, OR SEE “FREQUENTLY ASKED QUESTIONS” TAB ON OUR WEBSITE FOR OWNERSHIP
CHANGES)

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