Form 50-172 - Operator'S Request For Joint Taxation Of Mineral Interest Page 2
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2P r o p e r t y T a x
O p e r a t o r ’ s R e q u e s t f o r J o i n t T a x a t i o n o f M i n e r a l I n t e r e s t
Form 50-172
STEP 4: Continued
___________________________________________________________________________________________________
Owner’s Name
___________________________________________________________________________________________________
Present Mailing Address
___________________________________________________________________________________________________
City, State, ZIP Code
___________________________________________________________________________________________________
Owner’s Name
___________________________________________________________________________________________________
Present Mailing Address
___________________________________________________________________________________________________
City, State, ZIP Code
STEP 5: Sign the Form
I hereby request that the separate mineral interests in the property designated in this form be listed jointly in the manner specified herein.
I certify that the information given on this form is true and correct to the best of my knowledge and belief.
_____________________________________________________________________
___________________________
Signature of Designated Operator or Agent
Date of Request
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Page 2 • 50-172 • 03-12/3
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Parent category: Financial