Form 2179 – Revised 04/2023

Designation of Operator
(Form 2179)

Summary Designate an operator to act on your behalf for lease compliance. This does not transfer any lease interest — you remain responsible for the lease. Both you and the operator will sign.

Date(Required)

The undersigned is, on the records of the Trust Lands Administration, holder of lease,

Mineral Lease Number (ML)(Required)

And hereby designates:

Operator Name(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

as his operator and local agent, with full authority to act in his behalf in complying with the terms of the lease and regulations applicable thereto and on whom the Director of the Administration or his/her representative may serve written or oral instructions in securing compliance with the Rules and Regulations Governing the Issuance of Energy & Mineral Leases with respect to (describe acreage to which this designation is applicable):

Acreage

Acreage Description(Required)

Township

Range

Section

Legal Description

Acres

Total Acres(Required)

Operator agrees to comply with all lease provisions, statutes, rules, and regulations, whether federal, state, or local, in its operations on the subject lease.

It is understood that this designation of operator does not relieve the lessee of responsibility for compliance with the terms of the lease and the Rules and Regulations. It is also understood that this designation of operator does not constitute an assignment of any interest in the lease.

In case of default on the part of the designated operator, the lessee will make full and prompt compliance with all regulations, lease terms, or orders of the Director, Trust Lands Administration, or his/her representative.

The lessee agrees promptly to notify the Trust Lands Administration of any change in the designated operator.

Lessee Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address City State ZIP Code

Signature of Lessee(Required)

Date (Lessee)(Required)

Signature of Operator(Required)

Date (Operator)(Required)

Designation of Operator
(Form 2179)

Acreage

Services

Organization

Resources

Questions?

Designation of Operator (Form 2179)

Acreage

Services

Organization

Resources

Questions?

Designation of Operator
(Form 2179)