Form E Evidence of Authority

FORM E CONTRACT NUMBER

Approved by the Secretary of the Interior

March 20, 1952

UNITED STATES

DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS

OSAGE MINING LEASES

EVIDENCE OF AUTHORITY OF OFFICERS TO EXECUTE PAPERS

(To be sworn to by Secretary and President of a corporation and sealed with its seal.)

I solemnly swear that and

were on the day

of , 20 , the duly elected, qualified and acting president and

secretary, respectively, of

a corporation organized under the laws of

on which day they executed

mining lease for and in behalf of said corporation as lessee,

covering certain lands of the Osage Tribe; that they were fully empowered to

execute said lease and all papers in connection

therewith, and that their action in executing the same binds the said corporation

to full performance of all obligations thereunder.

This day of 20 .

(CORPORATE SEAL)

PRESIDENT

SECRETARY

Subscribed and sworn to before me this day of ,20 .

NOTARY PUBLIC

My Commission expires:

Paperwork Reduction Act (PRA) Statement: This information is collected to meet reporting requirements and is subject to the PRA. An agency may not request nor sponsor, and a person need not answer a request for information that does not display a valid OMB control no. A response to this request is required to obtain a benefit. The public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing the instructions, gathering and maintaining data, and completing and reviewing the form. Send comments on the burden estimate or any other aspect of this form to Information Collection Clearance Officer–Indian Affairs, 1849 C Street, NW, MS-3642, Washington, DC 20240.