Free 50-172 Operators Request for Joint Taxation of Mineral Interest - Texas

T S A

E X

Comptroller of Public Accounts FORM

50-172 (Rev. 7-97/2) [25.12 (6-82) Rule 9.3042]

YEAR

OPERATOR'S REQUEST FOR JOINT TAXATION OF MINERAL INTEREST
Appraisal district name Address Phone (area code and number)

To qualify for the taxation of minerals interests, other than interests having a taxable value of less than $500, the operator designated with the Texas Railroad Commission must submit this request form to the chief appraiser for the appraisal district in which the interest is appraised between January 1 and April 30 of this tax year.

Step 1: Identify the operator

Owner's name

Current mailing address (number and street) City, town or post office, state, ZIP code Phone (area code and number)

Step 2: Describe the Property

Property description: _________________________________________________________________________________________________

Types and amount of interest expressed in decimal form to be listed jointly in the name of the designated operator:

Step 3: Agent's name and address

Authorized agent (if different from above) Current mailing address (number and street) City, town or post office, state, ZIP code

Step 4: List owner's name and address (attach additional page if needed)

If all the nonroyalty interest(s) is not intended to be listed in the name of the designated operator, please list the names and addresses of the owners of such interest(s):
Owner's name Current mailing address (number and street) City, town or post office, state, ZIP code

Owner's name Current mailing address (number and street)

City, town or post office, state, ZIP code

Owner's name Current mailing address (number and street) City, town or post office, state, ZIP code

Owner's name Current mailing address (number and street) City, town or post office, state, ZIP code

Step 5: Sign the form

I hereby request that the separate mineral interests in the property identified in this form be listed jointly in the manner specified herein.

I certify that the information given on this form is true and corfect to the best of my knowledge and belief.

sign here

Signature

Date