Form BOEM-152 Relinquishment of Federal OCS Oil and Gas Lease

U.S. Department of the Interior

OMB Control No.: 1010-0006
Expiration Date xx/xx/2022

Bureau of Ocean Energy Management

RELINQUISHMENT OF FEDERAL OCS OIL AND GAS LEASE
Legal description of the lease/officially designated subdivision being relinquished:
_______________

Lease Number

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, subject to the provisions of 30 CFR 556, 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 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:
Name:

By:
Name:

Title:

Title:

Execution Date
Attach Notary Acknowledgement (not mandatory)

Execution Date

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. BOEM 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 section 26 of the OCSLA, 30 CFR 556.10 and in accordance with regulations in 30 CFR parts
550, 551, and 552. 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. Comments regarding the burden estimate or any other aspect of this form should be
directed to the Information Collection Clearance Officer, Bureau of Ocean Energy Management, 45600 Woodland Road, Sterling, VA 20166.

BOEM-0152 (June
(March2016)
2017)
BOEM-0152
Previous
Editions
are
Obsolete.
Previous Editions are Obsolete.

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 Record Title Owners 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 Record Title Owner.
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.
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 BOEM still must receive three originals for each separate lease or officially designated subdivision
being relinquished.
9. Relinquishments must be filed with a cover letter on company letterhead from a Record Title Owner.

BOEM-0152 (Month 2019)
Previous Editions are Obsolete.

PAGE 2 OF 2