(a) Name of applicant;
(b) Address of applicant;
(c) Description of land affected (including aggregate acreage);
(d) Fractional interest for which exemption is applied and nature of such interest;
(e) Recording data concerning the instrument creating the interest including grantor or lessor, grantee or lessee, date of instrument, book and page of record and date of filing;
(f) Length of primary term;
(g) Recording data on instruments divesting original party of any interest in a portion of original interest therein conveyed;
(h) Number of net mineral, royalty or lease acres on which exemption sought;
(i) Amount tendered therewith.
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