Affidavit of Service

STATE OF NEW YORK, 
COUNTY OF __________________________

(letter writer’s name here)_______________, being duly sworn, deposes and says that:
On (date)____________, I served a letter which contained a Notice of Termination of an Oil and Gas Lease, pursuant to New York General Obligations Law §15-304 (2), upon (gas company name)___________________________, by mailing an original thereof to: (gas company address)_____________________________________via Certified Mail, Return Receipt Requested.

Sworn to before me this
_____ day of __________________, ________
_____________________________ NOTARY PUBLIC