Fill and Sign the Division Orderunderstanding Oil and Gas Division Orders Form

ROYALTY OWNER'S STATEMENT OF OWNERSHIP DATE: TO: DIVISION ORDER DEPARTMENT (Company Name and Address) EFFECTIVE DATE: LEASE/DIVISION ORDER NUMBER: PROPERTY NAME: Each of the undersigned verify they are the owner(s) of royalties payable on oil, gas, and/or distillate, condensate, and other gaseous or vaporous substances and liquid hydrocarbons ("Oil or Gas") and warrant their ownership/division of interest in the proportions set out below of the Oil or Gas produced from an oil and gas lease, to the extent the lease covers the following lands located in ____ County, ____ (State) (the "Lands"): [Description of Lands] The undersigned verify the royalties are owned and payable according to the terms of a valid lease agreement(s) or pooling order(s) and are to be paid monthly according to all applicable federal and state laws to the named royalty owners for the interests shown opposi te each of their names, at the address(es) indicated. The owner(s) agree(s) to notify you in writing of any change in ownership of the identified interest(s). No transfer or change in ownership shall be binding on you until you are furnished with a copy of the instrument of transfer, or a transcript of proceedings satisfactorily evidencing a transfer or change of ownership. Any change or transfer of interest shall be made effective on the first day of the month in which you receive such notice. If monthly proc eeds attributable to the undersigned's interest is less than $____, sums due may be accrued until you have accumulated $_____ attributable to the interest, or until December 31 of each ye ar, whichever occurs first, at which time you will resume payments. This Statement of Ownership supersedes, cancels, and revokes any previous Division/Transfer Order or similar agreement which provided for payment of royalties on the Lands that has been issued by you, a predecessor, or any affiliate companies. Name of Royalty Owner(s) Address(es) Interest(s) Owned Witnesses:Owner Social Security/Tax ID Number: Witnesses: Owner Social Security/Tax ID Number: Witnesses: Owner Social Security/Tax ID Number: