Fill and Sign the Ratification and Consent to Pooling Andor Unitization Form

RATIFICATION AND CONSENT TO POOLING AND/OR UNITIZATION(By Overriding Royalty Interest Owner) STATE: COUNTY: OWNER: (Name and Address) EFFECTIVE DATE: Owner, named above, is the owner of an overriding royalty interest (the “Interest”) in the Oil, Gas, and Mineral Leases (the “Leases”) on the lands that are subject to t hose Leases (the “Lands”). The Leases and Lands are described in Exhibit “A” to this Ratific ation and Consent (the “Ratification”). Owner acquired the Interest by Assignment dated _____, from _____, as assignor, recorded in Volume _____, page _____ of the _____ Records of the county and state named above. The present owner of the Leases desires to pool and/or unitize all or part of the L eases and Lands they cover, in which Owner owns the Interest, with other lands that are not subject to the Leases. As evidence of this, the owners of the Leases have executed and recorded a Designation of Pooled Unit in the county where the Leases are located, describing the l ands and leases included in the Unit, created by that Designation. The Designation of Pooled Unit is dated ______, and recorded in Volume _____, Page _____, of the _____ Records of the county and state named above. For adequate consideration, the receipt and sufficiency of which is acknowledged by Owner, Owner consents to, approves, and ratifies the pooling or unitization of Owner's Interest in the Leases and Lands, with other lands or leases, as if Owner was a party to the Designation of Pooled Unit. Owner's Interest in the proceeds of production of oil and/or gas produced from a pooled unit in which all or part of the Leases and Lands are included, is to be paid on the same basis and manner, as the royalty reserved in the Leases. This Ratification shall apply to all of Owner's Interest which may be pooled or unitiz ed from time to time, and shall remain in effect so long as the Leases are in force and effect. For the consideration received, Owner agrees to execute any additional consents, ratifications, and writings which the lessee (present or future) of the Leases may request t o give full effect to Owner's consent and ratification. This Ratification is signed by Owner as of the date of acknowledgment of his signature below, but shall be effective as of the Effective Date stated above. Owner (Acknowledgment) [Exhibit “A”: Description of the Leases and the Lands they cover]