COMPLAINT FOR CLAIM OF ABANDONED MINERAL INTEREST I, , after being duly sworn according to law, would state to the Court as follows: 1. My full name is and I reside at . (address) 2. I am the current owner of record of a surface estate located at of record in Book , Page , Register's Office of County, Tennessee. 3. After inquiring with the county property assessor, I am not aware of any tax being paid for the mineral estate which underlies my surface estate. The mineral estate is of record (if known) in Book , Page , Register's Office of County, Tennessee. The name of the mineral interest owner (if known) is and the address (if known) is . 4. Upon reasonable inquiry, I am not aware of any use being made of the mineral estate underlying my surface estate as defined in Tennessee Code Annotated, §66-5-108 . 5. I believe the mineral interest is abandoned. 6. Upon the publishing of notice as required by Tennessee Code Annotated, §66-5-108 and the failure of the mineral interest owner to file a statement of claim, plaintiff demands that the mineral interest be declared to be abandoned, that the interest lapse and be reunited with the above-mentioned surface estate. This day of , 20 . (Signature of surface owner) State of Tennessee County of Personally appeared before me, (name of clerk or deputy) of the county, , the within named plaintiff, (plaintiff's name) having been duly sworn who acknowledged that plaintiff executed the within instrument for the purposes therein contained. Witness my hand, this day of , 20 . My commission expires: .
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Order The cause came to be heard this day of , 20 , before the Honorable , Chancellor of the Chancery Court for County, upon the Complaint for Claim of Abandoned Mineral Interest pursuant to Tennessee Code Annotated, §66-5-108 , and certification by the Clerk and Master that no answer has been filed after providing the notice required by that statute. The Court, therefore, finds that there has been no use of the mineral interest located at of record, if known, in Book , Page , Register's Office of County, Tennessee, as defined in Tennessee Code Annotated, §66-5-108 ; and the mineral interest has been abandoned. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the mineral interest located at (Address) , of record, if known, in Book , Page , Register's Office of County, Tennessee, is abandoned and that mineral estate shall be reunited to the surface interest titled to (name of surface owner) of record in Book , Page , Register's Office of County, Tennessee. Chancellor
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