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Operator(If Other than Permittee): <br /> Permittee Representative: Travis Crawford <br /> Certified Mail # <br /> In accordance with Rule 4.17.1(2)the Operator shall include the names,addresses and phone numbers of all <br /> owners of record to the affected land. Please attach additional sheets for this information if required. <br /> Name Address Phone Number <br /> Raymond A. Whitmire, Trustee 17880 Oswalt Road, Overbrook, OK 73453 918-208-2896 <br /> Potential Landowners: <br /> JW Cattle Ranch, L.L.C. P.O. Box 1722, Guymon, OK 73942 <br /> The Nature Conservancy 4245 North Fairfax Dnve,Suite 100,Arlington,VA 22203-1606 <br /> In accordance with Rule 4.17.1(4), if requesting a partial acreage release the Operator or their agent MUST sign that <br /> they have complied with the following statement: "All applicable portions of the Reclamation Plan requirements <br /> have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br /> Signature of Permittee, Operator or t authorized agent Date <br /> Important: In accordance with Rules 414 2(a) and 41710) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MmeralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />