CHANGE OF ADDRESS – OFFICIAL NOTICE
For the Oil, Gas, and Minerals Division
New Mexico State Land Office
Commissioner of Public Lands
Post Office Box 1148
Santa Fe NM 87504-1148
Dear Commissioner:
I am the holder of Oil & Gas Mineral Other ________________________
Lease # ___________ Assignment # ________ [Please list multiple leases on an attached page.]
of record in the New Mexico State Land Office, and I request that all official notices from your
office which are required to be sent to me by law or under the terms of my lease or contract be
sent to me at the new address shown below, which address shall remain unchanged upon your
records unless and until expressly directed in writing by me to do so.
______________________________________ __________________________________
Company name Print lessee’s or Attorney’s-in-fact name
_______________________________ __________________________________
Telephone E-mail address
________________________________________ _________________
Signature Date
PREVIOUS Address:
____________________________________________________________
Old post office or street address
____________________________________________________________
City State ZipCode
NEW, CHANGED Address
_____________________________________________________________
New post office or street address
_____________________________________________________________
City State ZipCode
Revised for web September 2004 ONLINE VERSION
CLEAR Form
