Lease Modification Form

OMB# 1076-0180

Expires XX-XXXX

MODIFICATION OF MINING LEASE

CONTRACT NO: APPROVED:

LESSOR: Osage Nation LESSEE:

Covering property described as: SW/4 of Section 30, Township 20 North, Range 12 East, Osage County, Oklahoma, containing 160 acres, more or less.

Now, therefore, the Gas Mining Lease is modified to include conventional Oil Mining Lease rights, pursuant to Osage Tribal Council Resolution 30-1235 and 25 CFR 226.

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

Lessee Signature: [Insert] Date

Lessor Signature: Chairman, Osage Minerals Council Date

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)

Superintendent, Osage Agency Date

Under the authority delegated by 200 DM 1, 209 DM 8, 230 DM 1, 3 IAM 4.1 and Muskogee Area

Addendum 9901 to 3 IAM 4 issued June 22, 1999.

Paperwork Reduction Act Statement: We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to identify and monitor lease operations. Your response is voluntary and we will not share the results publicly. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this survey and assigned OMB Control Number 1076-0180, which expires ##/##/####.

Estimated Burden Statement: We estimate the form will take you 1 hour to complete, including time to read instructions, gather information, and complete and submit the form. You may submit comments on any aspect of this information collection to the Information Collection Clearance Officer, Office of Regulatory Affairs & Collaborative Action—Indian Affairs (RACA), U.S. Department of the Interior, 1001 Indian School Road NW, Suite 229, Albuquerque, NM 87104.