Government of Canada / Gouvernement du Canada
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Canada Oil and Gas Land Regulations (C.R.C., c. 1518)

Regulations are current to 2024-05-28

SCHEDULE III(s. 111)Request

I, blank line, holder of Oil and Gas Permit No. blank line issued pursuant to blank line

(insert the reference to the Regulations under which the permit was issued)

and in effect on the 23rd day of September, 1957, hereby request from and after the day of filing of this Request with the Chief of the Resources Division, the said permit shall be subject to the Canada Oil and Gas Land Regulations.

Dated at blank line this blank line day of blank line, 19blank line

blank line
Signature of Permittee

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