Joint Royalty Address Change Form

(KY, MI, MT, ND, NY, OH, PA, VA & WV)

Date*
MM slash DD slash YYYY
Name
First Last
Owner Numbers*
Last Four of SSNs / Tax IDs*
Phone Numbers*
Email Addresses*
Please place a comma between each e-mail address specified.
Old Addresses*
New Addresses*
Consent*
By submitting this form, we verify that we are the above-named people and we authorize EnerVest Operating Company to make this requested address change.

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