Release Of Leases - Ohio Dnr Division Of Oil And Gas

ADVERTISEMENT

 
OHIO DEPARTMENT OF NATURAL RESOURCES
 
DIVISION OF OIL & GAS RESOURCES MANAGEMENT
 
2045 MORSE RD., F-2, COLUMBUS, OH 43229-6693
Phone: (614) 265-6922 • Fax: (614) 265-6910
 
EXEMPT DOMESTIC WELL OWNER AFFIDAVIT
 
RELEASE OF LEASE(S)
 
 
Owner Number____________
(To be filled in by the Division)
STATE OF___________________________________
SS:
COUNTY OF_________________________________
NAME OF ASSIGNOR/TRANSFEROR:_____________________________________________________________________
Please print name and title
ADDRESS OF OWNER:_________________________________________________________________________________
I the undersigned, being first duly sworn, depose and state that upon execution of this affidavit and the attached Form 7, I/We
have, as the assignor/transferor, released all the oil and gas leases that are included in the applicable formation of the drilling
unit for the respective well listed on the Form 7. The release is in a form such that the well ownership merges with the fee simple
interest of the surface tract and the release is in a form that may be recorded.
I have attached a copy of the release.
Permit No. _________________, known as the ___________________________________well #_________, located in
_________________________Township ________________________, County, Ohio
Further affiant sayeth naught.
Signature(s)/Title: ___________________________________________________________________________________
SWORN to before me and subscribed in my presence this ________ Day of _____________________, 20_________.
NotaryPublic: __________________________________________________
(Seal)
_________________________________________________
Date Commission Expires
***This is to be included as an attachment to the Request for Change of Owner (Form 7)
 
Page 1 of 1
 

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go