epsilon change of address form doc by housework


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									RE:      Change of Mailing Address

Dear Landowner,

In an effort to maintain our integrity and the confidence and confidentiality of our landowners, we
scrutinize requests to change account information. Therefore, we are asking you to verify your new
address in the space provided below. If there are two or more owners on the account, each owner must
complete this form. If the owner has an attorney-in-fact (Power of Attorney) who is acting on their
behalf, Epsilon requires a copy of the court order appointing that person as the owner’s POA or
guardian. Be sure to sign and date this change of address letter before mailing the form to our Traverse
City, Michigan office address below.

Attn: Lease Records
Epsilon Energy USA, Inc
3766 US 31 South
Traverse City, MI 49684

Please change mailing address to the following:

Owner Name:                                             Owner No.

Street or P.O. Box:                                     State Land is Located:

City, State, Zip:

         Social Security No. or Tax ID                          Telephone No.

         Owner Signature                                        Date

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