Pennsylvania Statutes Title 58 P.S. Oil and Gas § 905. Affidavit of termination, expiration or cancellation

(1) The names and addresses of the lessor and lessee.

(2) The municipality in which the land is located and a brief description of the land.

(3) If located in a unit, the name or description of the unit, if known to the lessor.

(4) If there is a well on the land, the name or number of the well if known to the lessor.

(5) The date of the execution of the oil or natural gas lease.

(6) The date of termination, expiration or cancellation of the oil or natural gas lease.

(7) A statement that the lessor complied with its duty to serve a notice to the lessee under section 4(a)  1 and that the lessee failed to provide a timely challenge to the notice as provided by section 4(c).

(8) A notarized signature of the lessor.