AFFIDAVIT OF POSSESSION INFORMATION SHEET
I. BACKGROUND INFORMATION A) Tract Name: ____________________________________________________________________________ B) Brief Tract Description: ___________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ C) County or Parish: ________________________________________________________________________ D) Date of Interview: _______________________________________________________________________ E) Affiant’s Full Name: _____________________________________________________________________ _________________________________________________________________________________________ F) Affiant’s Age: ___________________________________________________________________________ G) Affiant’s Date of Birth: ___________________________________________________________________ H) Affiant’s Place of Birth: ___________________________________________________________________ I) Affiant’s Current Address: __________________________________________________________________ J) Affiant’s Length of Residency at Current Address: _______________________________________________ K) Affiant’s Residence Relative to Subject Tract: _________________________________________________
II. PERTINENT QUESTIONS A) Have there ever been any adverse claims against the tract in question? ______________________________ If the answer is yes, have affiant explain. ________________________________________________________ __________________________________________________________________________________________ B) Have there ever been any boundary disputes involving the tract in question? __________________________ If the answer is yes, have affiant explain. ________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ C) Have any wells ever been drilled on the tract in question? _________________________________________ Has the tract in question ever been unitized? ___________________________________________________ 1) When was the well drilled? ______________________________________________________________ 2) What was the total depth? _______________________________________________________________ 3) Did the well produce or was it a dry hole? __________________________________________________ a) When did production cease? __________________________________________________________ b) Was the well plugged? ______________________________________________________________ c) When was the well plugged? __________________________________________________________ D) Has there ever been a search for any minerals other than Oil or Gas? ________________________________ If yes, explain ______________________________________________________________________________
__________________________________________________________________________________________ E) Are there any churches located on the tract in question? __________________________________________ 1) What is the name of the Church? __________________________________________________________ 2) Where is the approximate location relative to the tract in question? _______________________________ F) Are there any schools located on the tract in question? ___________________________________________ 1) What is the name of the school? __________________________________________________________ 2) Where is the approximate location relative to the tract in question? _______________________________ G) Are there any cemeteries located on the tract in question? ________________________________________ 1) What is the name of the cemetery? ________________________________________________________ 2) Where is the approximate location relative to the tract in question? _______________________________ _______________________________________________________________________________________ H) Are there any houses located on the tract in question? ____________________________________________ 1) Where is the approximate location relative to the tract in question? _______________________________ _______________________________________________________________________________________ I) Are there any Barns located on the tract in question? _____________________________________________ 1) Where is the approximate location relative to the tract in question? _______________________________ J) Are there any outbuildings located on the tract in question? ________________________________________ 1) Where is the approximate location relative to the tract in question? _______________________________ K) Have there been any drainage or other soil conversation measures carried out on the tract in question? _____ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ L) What are the boundary lines of the tract in question? (include: kind, condition, who built, any repairs, position, etc.) 1) North: _______________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 2) East: ________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 3) South: _______________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 4) West: _______________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
5) Any additional boundary information: _____________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ M) What is the chain of title? 1) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ e) When did the owner sell the tract in question? ____________________________________________ 2) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ e) When did the owner sell the tract in question? ____________________________________________ 3) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
e) When did the owner sell the tract in question? ____________________________________________ 4) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ e) When did the owner sell the tract in question? ____________________________________________ 5) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ e) When did the owner sell the tract in question? ____________________________________________ 6) Occupancy a) Who owned the tract in question? ______________________________________________________ ____________________________________________________________________________________ b) Did they live on the tract in question? ___________________________________________________ c) How did they use the tract in question? (e. g. timber, farming, pasture, type crops, etc.) ____________ ____________________________________________________________________________________ d) Were there any tenants on the tract in question? ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ e) When did the owner sell the tract in question? ____________________________________________