Type of Business and State of Incorporation of Grantee
If LP, Name Of GP
Tax Id #
Operator Contact
**** Please Note: For Oil and Gas-Related Pipelines ONLY
there is the option for a 10 year or 20 year term***
20 Year Term10 Year Term
Select Term
Operator
Operator Phone Number
System Name
RRC T-4 # (Copy of permit if available)
Last Safety Evaluation # (if available)
Year Built
Yes No
Interstate
Intrastate
Yes No
Is the area Pooled/Unitized?
Is the pipeline operating and used for
the original purpose stated in original
contract?
If no, what is the purpose
or is the line inactive?
If inactive pipeline in a Bay
area see Bay Pipeline Policy.
Signature of Applicant/Agent
Date
Email
Type of Business
State of Incorporation
Please note what is being amended and if this for an
assignment, you must include the GLO Easement
Numbers on the Bill of Sale. List the easement numbers
being assigned here as well or use this section to include any
additional information:
For assignments, the assignor and assignee must each fill out and
submit an application. Also, send one copy of the executed Bill of Sale
either by attaching it to the email that is created when you click the
"Submit by Email" button or by mailing it to the Texas General Land Office
c/o Right-of-Way Dept., PO Box 12873, Austin TX 78711-2873. We will
issue an assignment contract for all parties to sign once we receive all
requested information. Fees are located at the bottom of the next page.
Information collected by electronic mail and by web form is subject to the Public
Information Act, Chapter 552, Government Code.
Name (please print or type)
Easement No.
State of Texas
Texas General Land Office
Application for State Land Use Lease
Miscellaneous Easement/Right-of-Way - Renewal,
Assignment, or Amendment
Mailing
Address
City
Zip Code
Country
Company, Partnership, Individual or Trust Name
Grantee/Official Company Name/Applicant
Authorized Agent
Country
Email
Zip Code
City
Street Address
Work # Mobile #
Individual, Company, or Consultant Information
Agent/Company Contact
(Title, First Name, Last Name, Salutation)
Company Contact
Send contracts to Agent/
Company Contact
State
State
Website
Fax #Work #
Email