Fill and Sign the Affidavit of Voluntary Relinquishment of Parental Rights Form

AFFIDAVIT AS TO TERMINATION OF PRODUCTION PAYMENT STATE: COUNTY: Before me, the undersigned authority, on this day personally appeared (Name of Affiant), known to me to be the person whose name is subscribed to this Affidavit, who after having been first duly sworn, deposes and under oath stated:My name is ______. My address is _____. I am over the age of ______. I am the (Name of Position) with (Name of Company). I am familiar with the production payment interest (the “Production Payment”) crea ted in (Title of Instrument) dated ______, recorded in Volume ______, page ______ of the ______ Records of the County and State named above, between ______, as Assignor, and ______, as Assignee. The Production Payment, in the amount of $______, was to be paid out of a ______% interest in the proceeds paid for oil and/or gas produced from an Oil and Gas Lease da ted ______, recorded in Volume ______, page of the ______ Records of ______ County, ______ (the “Lease”), on the following lands located in that county and state (the “Lands”): (Description of Land) Several wells have been drilled and completed on the Lease and Lands and have produced oil and/or gas for the last ______ years. I have examined production records and determined there has been sufficient production sold from the wells on the Lease and La nds to fully satisfy the Production Payment. Although no release of the Production Payment appears of record in the county where the Lands are located, I have satisfied myself that production from the Lease and Lands has been sufficient to generate income to the Production Payment interest in excess of $______, the amount of the production payment reserved in the (Title of Instrument). Based upon these findings, the Production Payment is deemed to have been satisfied and no longer burdens the Oil and Gas Lease on the Lands. Date: Affiant