Company Name

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1. State in which search is to be conducted?

2. County or Parish where property is believed to be located:

3. Actual physical description if available: Section, Township, Range or Block & Survey:< br/>

4. Approximate date of property ownership (Month & Year):

5. Name of individual owner or the individual owners from whom the property was acquired or inherited OR a family name associated therewith:

6. Portion of ownership believed to hold, i.e., 1/2, 1/4th, decimal etc. if known:

7. Type of interest, i,e., minerals, oil & gas working interest, overriding royalty, etc.:

8. Any additional information that you believe could reduce the amount of time and expense in conducting a search:

Optional: Photo of Land: