Lease Modification Form

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS
OSAGE AGENCY

MODIFICATION

OF TERM(S) OF EXISTING LEASE

LEASE____________________

CONTRACT NO.: ____________ APPROVED: ______________________

It is hereby agreed by the following:

LESSOR: Osage Minerals Council and LESSEE:________________

Covering lands described as: ____________________________________________________

Containing: _______acres, more or less, be modified to reflect:

NOW, THEREFORE, the __________________Lease is modified to ____________________

________________________________________, pursuant to Osage Minerals Council Resolution ­­­­­­­­­­­­­­­No._________________ and CFR 226.

This modification does not change any of the terms, conditions, or stipulations except as specifically set forth herein,

Signature Line: _____________________________________________

Signature Line: _____________________________________________

LESSEE

Signature Line: _____________________________________________

CHAIRPERSON, OSAGE MINERALS COUNCIL

UNITED STATES DEPARTMENT OF THE INTERIOR

The modification is hereby approved and declared to be in accordance with the rules and regulations prescribed by the Secretary of the Interior, thereunder, and now in force, (25 CFR 226)

Date Approved: _____________________________________________

Signature Line: _____________________________________________

SUPERINTENDENT, OSAGE AGENCY

Under the authority delegated by 209 DM 8, 230 DM 1, 3 IAM 4.1 and Muskogee Area Addendum 9901 to 3 IAM 4 issued June 22, 1999.

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