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N <br />— <br />e <br />C , <br />EXECUTED THIS day of November, 2013. <br />STATE OF OKLAHOMA } <br />COUNTY OF TULSA <br />My commission expires: April 7, 2015 <br />My commission number 11003219 <br />(SEAL <br />}SS <br />} <br />m m <br />ri <br />m <br />m <br />C <br />z <br />D <br />CLAIMANT <br />INTEREST <br />REAL PROPERTY <br />located in Hall County, Nebraska. <br />ACKNOWLEDGMENT <br />NOTICE OF INTENTION TO PRESERVE MINERAL INTERESTS <br />STATE OF NEBRASKA } <br />} SS KNOW ALL MEN BY THESE PRESENTS: <br />COUNTY OF HALL } <br />This notice is intended to preserve an undivided severed mineral and/or royalty interest from <br />extinguishment pursuant to Sec. 57 -236 of the Civil Code. <br />NOW, THEREFORE, the John Hancock Life Insurance Company (U.S.A), successor by merger with <br />John Hancock Life Insurance Company, formerly known as John Hancock Mutual Life Insurance Company, <br />Farmers National Company, Agent, 5110 South Yale, Suite 400, Tulsa, OK 74135, does hereby claim: <br />An undivided severed mineral and/or royalty interest in the land described below: <br />Sections 3, 5 & 16, Township 11 North, Range 11 West, 6 P. M. <br />I assert under penalty of perjury that this notice is not recorded for the purpose of slandering title to <br />real property and I am informed and believe that the information contained in this notice is true. If this notice <br />is made on behalf of a claimant, I assert under penalty or perjury that I am authorized to act on behalf of the <br />claimant. <br />Farmers National Company, Agent <br />John Hanco .,, ife Insurance Co <br />By: <br />David Smith, ice Presi• e <br />The foregoing instrument was acknowledged before me this/5 day of November 2013, personally <br />appeared David L. Smith, Vice President of Farmers National Company, on behalf of the corporation as such Agent <br />and not otherwise. <br />r <br />CD <br />Farmers National Company, Agent <br />John Hancock Life Insurance Company (U.S.A) <br />Return to: Jennifer Kindred <br />5110 South Yale, Suite 400 <br />Tulsa, OK 74135 <br />CZ) -t <br />z rn <br />a <br />-n <br />71: MI <br />r <br />(n <br />(f) <br />cn <br />C) <br />- n <br />(U.S <br />CO <br />rn <br />C <br />z <br />