Consolidation Of State Oil And Gas Leases Form - 2016 Page 2
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2be considered as an abandonment of such operations as to any lease from the State of New Mexico included
in this agreement.
Requesting approval of consolidation of NM state oil and gas leases
__________________________________________For_________________________________________
Print person’s name
Corporation
________________________________________
Signature
Acknowledgment in an Individual Capacity:
State of ________________________)
ss)
County of ______________________)
This instrument was acknowledged before me on ___________________ Date
by ____________________________________________________________________
Name(s) of Person(s)
_______________________________________
(Notary Seal)
Signature of Notarial Officer
: __________________
My commission expires
Acknowledgment in a Representative Capacity:
State of ____________________________)
ss)
County of __________________________)
This instrument was acknowledged before me on _____________________ Date
by ________________________________________________________________________________
Name(s) of Person(s)
as ____________________________________ of ___________________________________________
Type of authority, e.g., officer, trustee, etc.
Name of party on behalf of whom this instrument was executed
______________________________________
Signature of Notarial Officer
(Notary Seal)
: __________________
My commission expires
ONLINE version
2
Consolidation of leases
May 2016
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