Form BOEMRE MMS-152 BOEMRE MMS-152 Relinquishment of Federal OCS Oil and Gas Lease

U. S. Department of the Interior OMB Control Number: 1010-0006

Bureau of Ocean Energy Management, OMB Approval Expires: xx/xx/xxxx

Regulation and Enforcement

RELINQUISHMENT OF FEDERAL OCS OIL AND GAS LEASE

Legal description of the lease/officially designated subdivision being relinquished:

The owner(s) of one hundred percent (100%) of the record title interest does (do) hereby release, relinquish and forever quitclaim all of its (their) right, title and interest in and to the oil and gas lease, or subdivision thereof, described above.

This relinquishment is effective as of the date it is filed with the appropriate OCS office of the Bureau of Ocean Energy Management, Regulation and Enforcement, subject to the provisions of 30 CFR 256, Subpart K, Termination of Leases.

This instrument may be executed in any number of counterparts, each of which must be deemed an original instrument, but all of which together must constitute but one and the same instrument provided. However, this instrument and any other counterpart hereof, will not be binding unless and until executed by all of the parties, and will not be accepted by the Bureau of Ocean Energy Management, Regulation and Enforcement unless all counterparts are filed simultaneously.

Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction

Insert name and Company number of each Lessee

LESSEE: LESSEE:

By:________________________ By:__________________________

Name: Name:

Title: Title:

___________________________ _____________________________ Execution Date Execution Date

Attach Notary Acknowledgement (not mandatory)

Paperwork Reduction Act of 1995 (PRA) Statement:  The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to use in the adjudication process involved in leasing and lease operations. The BOEMRE uses the information to track ownership of leases in the Federal OCS. Responses are mandatory (43 U.S.C. 1334).  Proprietary data are covered under 30 CFR 250.197.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number.  Public reporting burden of this form is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form.  Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Mail Stop 5438, Bureau of Ocean Energy Management, Regulation and Enforcement, 1849 C Street, NW, Washington, DC 20240.

BOEMRE FORM MMS-152 (Mo/Year – Supersedes all previous editions of form MMS-152 which may not be used). Page 1 of 2

INSTRUCTIONS

FOR

RELINQUISHMENT OF FEDERAL OCS OIL AND GAS LEASE

1. Form must be typed.

2. Fill in the complete legal description of the lease or officially designated subdivision (described in aliquots not less than ¼ ¼ ¼ of the block) being relinquished, including the OCS lease number.

3. Enter names of owners (lessees) of one hundred percent (100%) of record title interest in the lease or officially designated subdivision being relinquished. The company number must be identified next to the name of each Lessee.

4. Do not include or request an effective date. The relinquishment is effective on the date it is filed in the appropriate OCS office of the Bureau of Ocean Energy Management, Regulation and Enforcement.

5. No filing fee is required.

6. Witnesses, notarial acknowledgements and corporate seals are not required, although you may include these if you wish.

7. This form may be duplicated by means of word processing software, but any duplicate that differs from the approved form, will be deemed to include any omitted language as if it were the original form.

8. Relinquishments must be filed in triplicate. If multiple leases are relinquished in the same instrument, the BOEMRE still must receive three originals for each separate lease or officially designated subdivision being relinquished.

BOEMRE FORM MMS-152 (Mo/Year – Supersedes all previous editions of form MMS-152 which may not be used). Page 2 of 2