Signature
State of Texas
Texas General Land Office
Questionnaire for the purchase or lease
of unsurveyed school land or
for the purchase of excess acreage
SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned notary public, on this the day of
, 20 .
Notary Public, State of Texas
My commission expires:
1. Describe the topography of the land and how it is presently used
2. What is the assessed per acre value placed on this property by the Central Appraisal District?
$
(Please attach a copy of the latest tax statement)
3. Is the tract currently under an oil and gas lease?
Yes No
If yes, fill out the following:
Current Lessee
Date of Lease
Bonus Received (per acre) $
Delay Rental $ Primary Term
4. Is there production on this tract?
Yes No
If yes, fill out the following:
Operator
Number of Producing Wells
Name of the field in which the wells are located
Royalty Fraction
Royalty Payments $
5. Which of the following describes your right to (1) purchase or lease the unsurveyed school land; or (2) purchase
excess acreage:
Owner of the survey Owner of portion of the survey Owner of percentage interest of the survey
6. Is this tract of land currently on the market to be sold and if so, what is the asking price?
Yes No
$
Date
By clicking this box, I verify the information submitted is true
and correct according to the best of my knowledge
(Notary Seal)