Fill and Sign the Title 68 Real and Personal Property Form

Page 1 of 2 DISSOLUTION OF POOLED UNIT(By Unit Owners) STATE: COUNTY: UNIT OWNERS: (Names and Addresses) EFFECTIVE DATE: By instrument entitled (Designation/Declaration) of Unit, dated to be effective _____, recorded in Volume _____, page _____, of the _____ Records of _____ County, _____, the owners of the leasehold estate in the Oil and Gas Leases described in Exhibit “A” to this Dissolution of Unit (the “Leases”), pursuant to the authority granted in each of the Lea ses, (all/part) of the Leases were pooled to form the _____ Unit (the “Unit”) for the production of (oil/gas). The lands subject to the Leases included in the Unit are described in Exhibit “B” to this Dissolution of Unit (the “Lands”). The parties to this Dissolution are the present owners of the Leases (or portions of the Leases) that are included in the Unit (the “Unit Owners”). The purpose for which the Uni t was formed no longer exists, and the Unit Owners desire to dissolve the Unit, terminate its e xistence, and declare the Leases to no longer be included in the Unit. By mutual consent, the Unit Owners declare that the Unit created by the Designati on of Unit described above is dissolved, terminated, and no longer in effect, and the Leases i ncluded in the Unit are no longer subject to the (Designation/Declaration) of Unit, or maintained by production from or operations on the Unit, but each of the Leases shall, from and after the Effective Date, be only maintained according to the terms, conditions, and provisions of ea ch of the separate Leases. The Unit Owners declare that each of them, on dissolution and te rmination of the Unit only own interests in the Leases in which they are the original Lessee or have been assigned an interest, and such assignment(s) appear of record in the records of the County in which the Leases are located, and do not own any interests in Leases in which they are not the record owner, but were deemed to own an interest as a result of the (Designation/Declarati on) of Unit; i.e., any imputed or implied cross-conveyances resulting from the formation of the Unit are deemed to have terminated, as of the Effective Date, and no longer be in force and effect. This Dissolution of Unit may be executed by the Unit Owners in any number of counterparts and all counterparts taken together shall constitute one instrument. For recording purposes the signature pages of the separately executed counterparts may be combined to form one instrument. This Dissolution of Unit, or a counterpart of it, is executed by each Unit Owner as of the date of the acknowledgement of their signature, but shall be deemed effective as of the Effective Date stated above. Page 2 of 2 Unit Owner Unit Owner (Acknowledgments) Exhibit A: Description of Leases included in the Unit. Exhibit B: Description of Lands included in the Unit.