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WAIVER FOR BOND TO PROTECT SURFACE

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WAIVER FOR BOND TO PROTECT SURFACE Powered By Docstoc
					NEW MEXICO STATE LAND OFFICE – OIL, GAS, AND MINERALS DIVISION Surface Owner/Lessee WAIVER of Bond Requirement – Online Version
hereby grants waiver of bond
SurfaceOwner / Lessee – Print or type name

to

proposing to occupy and
Mineral Lessee or Operator – Print or type name

use the tract of land, herein designated, for development of oil and gas operations. Lease # Subdivisions Sect , Twp Assignment # , , Rng , NMPM County, NM. _________________ Date

__________________________________________________________
Signature(s) - Representative(s) of Surface Owner or Lessee

Print or type NAME(s) and TITLE(s) of person(s) signing above.

Acknowledgment in an Individual Capacity
State of
ss

County of This instrument was acknowledged before me this By , . ___________________________________________
Signature of Notarial Officer
(Seal)

day of

, 20

Name(s) of Person(s)

My commission expires

Acknowledgment in a Representative Capacity
State of
ss

County This instrument was acknowledged before me this By
Name of Person representing company

day of

, 20

As

of
Type of authority; e.g., officer, trustee, etc. Name of party on behalf of whom instrument was executed

___________________________________
Signature of Notarial Officer
(Seal)

My commission expires
Revised for Web November 2004


				
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posted:12/15/2009
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