Fill and Sign the Claim Mineral Form

COMPLAINT FOR CLAIM OF ABANDONED MINERAL INTEREST I, __________________, after being duly sworn according to law, would state to the Court as follows: 1. My full name is __________________ and I reside at ______________________________. (address) 2. I am the current owner of record of a surface estate located at __________ of record in Book __________, Page ____, Register's Office of ________ County, Tennessee. 3. After inquiring with the county property assessor, I am not aware of any tax being paid for the mineral estate which underlies my surface estate. The mineral estate is of record (if known) in Book ____, Page ____, Register's Office of __________ County, Tennessee. The name of the mineral interest owner (if known) is _____________ and the address (if known) is __________________. 4. Upon reasonable inquiry, I am not aware of any use being made of the mineral estate underlying my surface estate as defined in Tennessee Code Annotated,  66 - 5 - 108. 5. I believe the mineral interest is abandoned. 6. Upon the publishing of notice as required by Tennessee Code Annotated,  66 - 5 - 108 and the failure of the mineral interest owner to file a statement of claim, plaintiff demands that the mineral interest be declared to be abandoned, that the interest lapse and be reunited with the above - mentioned surface estate. This ____ day of ____________, 20___. ________________________________ (Signature of surface owner) State of Tennessee County of ____________ Personally appeared before me, ___________________________________________ (name of clerk or deputy) of the county, ______________________________, the within named plaintiff, (plaintiff's name) having been duly sworn who acknowledged that plaintiff executed the within instrument for the purposes therein contained. Witness my hand, this ____ day of ____________, 19____. __________________________________ My commission expires: ________________________.