HomeMy WebLinkAbout911993Form 3000-3
(October 1992)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
000235
ASSIGNMENT OF RECORD TITLE INTEREST IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351-359)
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Barbara lllan
FOR~ AVP~OV~D
OMB NO. 1004-0034
Expires: July 31, 1995
Lease Serial No.
WYW-0322062
Lease effective Date
(Anniversary Date)
New Serial No.
Type or print plainly in ink and sign in ink,
PART A: ASSIGNMENT
1. Assignee* Simpson, Trustee Of The Barbara Allan Simpson 2002
Seeet 288 Fernwood Drive Trust, Dated April 5, 2002
City, State, ZmCode Moraga California 94556
* If more than one assignee, check here [] and list the name(s) and address(es) of all additional assignees on the rexerse of this form or on a separate attached
sheet of paper.
This record title assignment is for: (Check one) [] Oil and Gas Lease, or ['"] Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) [] Record Title, [] Overriding Royalty, payment out of production or other similar
interests or payments
2. This assi[nment conveys the followin[~ interest:
Land l~escription Percent of Interest Percent of
Owned Conveyed Retained Overriding Royalty
Additional space on reverse, if needed. Do not submit documents or agreements other than or Similar Interests
this form; such documents or agreements shall only be referenced herein. Reserved Previously
reserved
or conveyed
a b c d E f
Township 23 North, Range 112 West
Section 23 : SE/SE/4 Of Of
Lincoln, County Wyoming Recorc All None None Recor
RECEIVED 9/19/2005 at 2:57 PM
RECEIVING # 911993
BOOK: 598 PAGE: 235
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
FOR BLM USE ONLY -DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or equitable
title to this lease.
[] Assignment approved for above described lands; [] Assignment approved for attached land description
[] Assignment approved for land description indicated on reverse
Assignment approved effective of this from.
By
(Authorized Officer) (Title) (Date)
Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in Item No. 2, if needed.
0 L'1,993 i.'00236
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
The Assignor certifies as owner of an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above.
Assignee certifies as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the laws
of the United States or of any State or territory thereof. For the assignment of NPR-A leases, assignee is a citizen, national, or resident alien of the United States or
association of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Assignee is not considered a minor under the
laws of the State in which the lands covered by this assignment arc located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and
acquked lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options), or
300,000 acres in leases in each leasing Disb'ict in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance
with the Mineral Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal lease; (d) All parties holding an interest in the assignment arc
otherwise in compliance with the regulations (43 CFR Group 3 I00 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation requirements
for all Federal oil and gas lease holdings required by sec. 17(g) of the Mineral Leasing Act; and (f) Assignee is not in violation of sec. 41 of the Mineral Leasing Act.
Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described
herein.
For geothermal assignments, an overriding royalty may not be less than one-fourth ('A) of one percent of the value of output, nor greater than 50 percent of the rate of royalty
due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241).
I certify that the statements made herein by me are tree, complete, and correct to the best of my knowledge and belief and are made in good faith.
Executed this ~ ~4~ ~ ,2005. Executed this ~ 4 '~.~M4a ~.._~
__day of - day of
Name ofAssignor as shown on current lease Barbara A. Simpson
,2005.
Assigno~ ~
or B-~rbara A. Simpson(5
Attomey
in-fact
288 Fernwood Drive
(Assignor's Address)
Moraga CA 94556
(City) (State) (Zip Code)
Barbara Allan Simpson, Trustee
Of The Barbara Allan Simpson
Assignee ,~ ,., ,., .
or 2uu/- Tiu~L, DoLed Apb-il 5, 200
Attorney-in-Fact ~~~.~
Barbara Allan Simpson,
Trustee
Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or arly other aspect of this form to U.S. Department of the Interior, Bureau of Land
Management, (Alternate) Bureau Clearance Officer, 0VO-771), 1849 C Street, N.W. Washington, D.C. 20240, and the Office of Management and Budget, Paperwork
Reduction Project (1004-0034), Washington, D.C. 20503.
Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency of the United States any false, fictitious or fraudulent
statements or representations as to any matter within its jurisdiction.
:':'00237
Ol 4t, hm I, ~---before me .~LI ~_~ ,/NT2 ~~ N~~rq ,
Not~ Pubhc (here lnse~ ~me ~d t~tle of officer) personally abpe~ed
b~~ ~ · ~ ~ M~0~ , personally ~o~ to me (or proved to me on the basis of
satisfacto~ evidence) to be the person whose nme is subscribed to the with~ instment ~d
ac~owledged to me that she executed the sine in her au~orized capaciW ~d that by her silage
on the instment the person or the entiW upon behalf of w~ch the person acted, executed the
instrument. ~
~T~SS my h~fficial seal.
Signature k~ 2 } (Seal)
SUZI A~OOD r
COMM. ~ 134~70 ·
N~OTARY PUBUC-C~FORN~ ~
CONTRA COSTA COUN~ ~
] My Commi~ion ~ires ~. 19, ~ [