Form B "Transfers and Assignments of State Leases Statement of Conveyance" - Louisiana

What Is Form B?

This is a legal form that was released by the Louisiana Department of Natural Resources - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 9, 2015;
  • The latest edition provided by the Louisiana Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form B by clicking the link below or browse more documents and templates provided by the Louisiana Department of Natural Resources.

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Download Form B "Transfers and Assignments of State Leases Statement of Conveyance" - Louisiana

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OFFICE OF MINERAL RESOURCES
STATE OF LOUISIANA
BATON ROUGE, LA
FORM B
TRANSFERS AND ASSIGNMENTS OF STATE LEASES
STATEMENT OF CONVEYANCE
CONVEYOR'S NAME & ADDRESS
EFFECTIVE DATE
LINE #
NAME
GROSS
OF TRANSFER
1
a
STREET
WORKING
(DATE OF SALE)
b
CITY/STATE
INTEREST
c
PHONE NUMBER
d
OWNER'S INTEREST BEFORE CONVEYANCE
e
OWNER'S INTEREST AFTER CONVEYANCE
STATE LEASE
f
INTEREST CONVEYED BY OWNER
NAME & ADDRESS OF TRANSFEREE(S)
2
a
NAME
b
STREET
LEASE ROYALTY DECIMAL
c
CITY/STATE
d
PHONE NUMBER
3
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
4
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
5
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
6
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
7
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
8
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
9
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
TOTAL (must equal the amount on line 1f )
PORTION DESCRIPTION:
COMMENTS:
PREPARED BY:
DATE:
Phone Number
formb 9/9/2015
E-mail Address
OFFICE OF MINERAL RESOURCES
STATE OF LOUISIANA
BATON ROUGE, LA
FORM B
TRANSFERS AND ASSIGNMENTS OF STATE LEASES
STATEMENT OF CONVEYANCE
CONVEYOR'S NAME & ADDRESS
EFFECTIVE DATE
LINE #
NAME
GROSS
OF TRANSFER
1
a
STREET
WORKING
(DATE OF SALE)
b
CITY/STATE
INTEREST
c
PHONE NUMBER
d
OWNER'S INTEREST BEFORE CONVEYANCE
e
OWNER'S INTEREST AFTER CONVEYANCE
STATE LEASE
f
INTEREST CONVEYED BY OWNER
NAME & ADDRESS OF TRANSFEREE(S)
2
a
NAME
b
STREET
LEASE ROYALTY DECIMAL
c
CITY/STATE
d
PHONE NUMBER
3
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
4
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
5
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
6
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
7
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
8
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
9
a
NAME
b
STREET
c
CITY/STATE
d
PHONE NUMBER
TOTAL (must equal the amount on line 1f )
PORTION DESCRIPTION:
COMMENTS:
PREPARED BY:
DATE:
Phone Number
formb 9/9/2015
E-mail Address