Individual Royalty Address Change Form

(AR, CO, KS, LA, NM, OK, TX, UT)

Date*
MM slash DD slash YYYY
Name
First Last
Owner Number*
Last Four SSN/Tax ID*
Phone*
Email*
Old Address
New Address
Consent*
By submitting this form, I verify that I am the above-named person and I authorize EnerVest Operating Company to make this requested address change.