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Agreement to enter property into the roles of “Central Broome Landowner Association Pool” 

PLEASE PRINT PAGE AND FILL OUT (copy and paste to new page or highlight and print selection)and personally deliver to a steering committee member or mail to :
Central Broome Association POB #1, Bible School Park , N.Y. 13737

As noted by signature on this document, I request the “Central Broome Property Association Pool” add my land to the list for the purpose of negotiating a Gas and Oil Lease Agreement for the acreage as listed below.

The negotiating “Central Broome Property Association Pool” is currently being directed by a Steering Committee and the members are;

Kermit Kirby           Dave Fendick              Larry W. Haskell                   

Dave Johnson         Mike Comfort              Ron Phillips                          

Our goal is to gain fair and equitable up-front-payments and royalties while still protecting the rights and property of the landowners. We plan to seek professional assistance in negotiations and in development of leases.  This document is an offer to join a land group to enhance the negotiation of a gasand oil lease and is not associated with any gas or oil company.   Further this commitment is a good faith signing that you will work with the group in obtaining a lease and not sign with any lease outside of the group. Further this agreement does not compel you to sign any lease orchestrated by the group.  

Description (The parcel number or tax map number is located on your property tax bill and must be correct).

Tax or parcel #                      Acres                  Tax or parcel #                 Acres

________________                _____              _________________          ________

________________                _____              _________________          ________

_____________________________________________________________________

_____________________________________________________________________

 
list additional properties on back of sheet
Is any of your listed property currently under an oil or gas lease?     Yes        No   (please circle)

Your name and mailing address:

_______________________________________________________________________

Property address:

_______________________________________________________________________

 
County_______________                        Town_________________________

Name the property is in:_______________________________________________________

phone number and e-mail:______________________________________________________

Signature: ­­­ ­­­­­__________­­­­_____­­­­­­­                                            Date: ________