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HomeMy WebLinkAbout913539 - '. ", ',; !;;~~~\iIZ'¡~¡l~¡I¡',:":':: i';'~!:':':':", ':'~ji:r:-:'; ::~ ;:'~;.i~'\!¡,:;:'¡~;V: "~,, ;. , ·lA,:'. '.'"r.,f>~ ': ·::>:I~·:~,,;·)O:·¡'-i· .~¡ .._. ,;,' ,"; ":'f,~J~'.;:'; , '. '..·'¡:I~:'V"'·,· '~'.' '-' i;¡"¡1 r.;!¡~i;-:';:;¡; '. ~. , . C00127 . l~ \tnt.\\\U~ , r ~ );~.I 3~l\' \ \ ,\ \\~\)t.\.\n\ \ ,,·;;('t,A\\. \!\ ' ~'" . - ~Ü ~fb 0~2) 1"\ .,\~i\'tl\ t Q. ß\.;1 'J '. . \ Þ.h -.r BUREAU OF LAND MANAGEMENT 1m) þ,úG -- ~ASSIGNMENT OF RECORD TITLE INTEREST IN A '~', !.:;- í'.( \\1.. t.' s FOR OIL AND GAS OR GEOTHERMAL RESOURCES r\ t.: '--' ~ ~{) CUt '{ t.}\~t.., Mineral Leasing Act of 1920 (30 D.S.C. 181 et seq.) \ \ - Act for Acquired Lands of 1947 (30 U.S,C 351 - 359) Geothermal Steam Act of 1970 (30 D.S.C. 1001 -1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 D.S.C. 6508) UNITED STATES DEP AR TMENT OF THE INTERIOR FORM APPROVED OMB NO. 1004 - 0034 Expires: October 31, 2004 Lease Serial No. SEE EXHIBIT 'A' Lease Effective Date (Anniversary Date) New Serial No. Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT 1. Assignee* SEE BELOW Street City, State, Zip Code *If more than one assignee, check here 0 and list the name( s) and address( es) of all addtional assignees on page 2 of this fonn or on a separate attached sheet of paper. This record title assigmnent is for: (Check one) 0 Oil and Gas Lease, or Interest conveyed: (Che<:k one or both, ar appropriate) [{] Record litle, o Geothennal Lease D Overriding Royalty, payment out of production or other similar interests or payments 2. This assignment conveys the following interest Land Descri tion Additional space on page 3, ¡fneeded. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein. Percent ofInterest Owned Conveyed Retained Percent of O,,:er~iding Royalty Slmtlar Iñterests a b ReseIVed Previously reseIVed or conveyed c d e f 10% 0.00% Of Record SEE ATTACHED EXHIBIT 'A' FOR LEGAL DESCRIPTION Condor Exploration, LLC, Assignor 100% Palace Exploration Company, Assignee 1202 East 33rd Street Tulsa, OK 74105-2048 68.4% RZ, Inc., Assignee 1202 East 33rd Street Tulsa, OK 74105-2048 03.6% ~ Il. o ~ N ..... CO ~ o o ~~ :;:: (9 ,.... z FOR BlM USE ONLY . DO NOT WRITE BELOW THIS LINE fn ~ UNITED STATES OF AMERICA > () This assignment is approved solely for administrative purposes. Approval does not WX;rll. nt that either party to this assignment holds legal or equitablt jjj ~ title to this lease. U o Assignment approved for above described lands; Assignment approved for attached land description ~ Assignment approved effective S EP 0 12005 0 Assignment approved for land description indicated on reverse of this form Nevada Petroleum Corporation, Assignee 1470 NE 1st Street, Suite 100 Bend, OR 97701 08% Horsetrap Partners LLC, Assignee 2371 Brighton Circle Medford, OR 97504 10% /SI Pamela J. Lewis (Authorized Officer) (Continued on page 2) ChiA{j Branch of Fluicj Minerals AdjUdicatioSEP 2 9 2005.-- (Title) (Date) t fOR IIG;.;.:,;,;';';;;':':-;]". EE r,:,:'];j;l;H¡;j¡~n~!}~~_;~B' By f::P' ' ,¡'S ',·, ",' 1!::::~Û:;:t::::::;~::~ 28!.:~:~L!;;> ( 3~ ~ a: w a: w t-- ~ N a: ~ cn....ww Mù..iZ~ ~(9(9':L "",<c<Ca: cnll.~W W ...J Z () Z~ "<t L'5 Z 0-,:) Cþ 0 ~ () o Z o ...J (]) 0 () Z :J ·....... A . 2. II: -<iO;z 00 ~-i B~?:;:tI ëñ~-<Q CJ).,,»~ "'6~zQ ¡z!::O~ ..ZC")'cn io.cnf!.1 ·omF (O);DZ O>m ...-.J(¡') :-'~o itnZ ..... '..~ ;,:"o!~~...!.i~", .!i!. "¡! t::: ~:L'!: ~ _.,--,."._.. .:"..i' %~;~!m~¡~lI;:· 0913539 _...... ..~.......,.,...> "~,,I-<';:;ì ,~?,.' ,..,:" .--.:." 'I·: "!;!~;'~' .. -." 1"'\ n .J ~) 8 u ,} .1:.. (.., Part A (Continued): ADDITIONAL SPACE for names and addresses of additional assignees in Item No. I, if needed. By: Dated: HOR~~A~ . By: ~ ('.\~r (-\l.O<;' Dated: ACKNOWLEDGMENT(S) STATE OF OKLAHOMA ~o Zoot- 0(')8 z(!J~C\ ....IWW(QU) « CI) a: (') C\ wa:C?ó Z CI)<üz « ....I....I::Jz ~ ~~moOJ üw::J-cc ü: 0 CL CI) D: IL:>->CI) x ° ....ICI: ~ OJ <<t:~ z I- 00 °oii) Z-cn 3Ë ::E o Ü >- :2. J. PART B - CERTIFICATION AND REQUEST FOR APPROVAL The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above (Continued on page 3) 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 t e laws of the United States or of any State or territory thereof. For the assignment ofNPR-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 are located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and acquired 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 District 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 anyone State if this is a geothermal lease; (d) All parties holding an interest in the assignment are otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation requirements for all Federal oil and gas lease holdings as 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 here in. or geothennal assignments, an overriding royalty may not be less than one-fourth (1/4) 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). Executed this day of }U.LH I certify that the statements made herein by me are truè, complete, and correct to the best of my knowledge and belief and are made in good faith. 20 öS 20_ Executed this day of Assignee or Attorney-in-fact (Signature) Assignor or Attorney-in-fact (Signature) 7720 E BelIeview, Suite B-I02 (Assignor's Address) Denver Colorado (City) (Signature) (State) 80111 (Zip Code) Public reporting burden for this fonn 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 any other aspect of this fonn to U.S. Departmen.t of the Interior, Bureau of Land Management (I 004-0034), Bureau Infonnation Collection Clearance Officer, (WO-630), Mail Stop 401 LS, 1849 C Street, N.W., Washington, D.C. 20240. Title 18 V.S.C. Sec.IOO! 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. ~ (Form 3000-3. page 2) , '. 'i'.' .!.,.~:' 1': 'I !':'::;'. ù913S:jS .,...........",...,.,'.. " ;, ~ " i;':,,~::.:I_· ',"::J:..:,',·i;_;',~,'¿~,·,-..-, " cn04 r'g J...J j_t{~ PART C - GENERAL INSTRUCTIONS 1. Assignor/Assignee must complete Parts Al and A2 and Part B. All parties to assignment must sign as follows: The assignOl(s) must manually sign 3 original copies and the assignee(s) must manually sign at least I of the 3 original copies. File three (3) completed copies of this fonn in the proper BLM office for each assignment of record title. For a transferof overriding royalty interest, payment out of production or other sin1ilar interest or payment, me one (I) manually signed copy of this fonn. The required filing fee (nonrefundable) must accompany the assignment. File assignment within ninety (90) days after date of execution of assignor. 2. Separate fonn must be used for each lease being affected by this assignment and for each type of interest conveyed. 3. In Item No.2 of Part A, describe lands affected (See 43 CFR 3106, 3135 or 3241). For column b, c, d, and e, enter the interest expressed as a percentage of total interest in the lease; e.g., if assignor assigns one quarter of a 20% in- terest, enter 20% in column b, 5% in column c, and 15% in column d. 4. If assignment is to more than one assignee, enter each assignee's name across The Paperwork Reduction Act of 1995 requires us to inform you that: 1. "This infonnation is being collected pursuant to the law. 2. This information will be used to create and maintain a record of oil and gas/geothermal lease activity. 3. Response to this request is required to obtain benefit. BLM would like you to know that you do not have to respond to this or any other Federal agency sponsored infonnation collection unless it displays a currently valid OMB control number. NOTICE The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d)providethat you be fumishedthe following information in connection with ùûonnation required by this oil and gas/geothermal lease record title assignment application. AUTHORITY: 30U.S.C.181 et seq.; 30 V.S.C. 1001-1025; 42 V.S.C. 6508 PRINCIPAL PURPOSE: The information is to be used to process record title as- signments for oil and gas/geothermal resources leases. 2 This assignment conveys the following interest (continued): 5. If any payment out of production or similar interests, arrangements or payments have previously been created out of the interest being assigned,or ifany such payments or interests are reserved under this assignment, include a statement giving full details as to amount, method of payment, and other pertinent tenus as provided under 43 CFR 3106, 3135, or 3241. 6. The lease account must be in good standing before this assignment can be ap- proved as provided under 43 CFR 3106and 3241. 7. Assignment, if approved, takes effect m the first day of the month following the date of filing in the proper BLM office. If a bond is necessary, it must be fur- nished prior to approval of the assignment. 8. Approval of assignment of record title to 100% of a portion of the leased lands creates separate leases of the retained and the assigned portions, but does oct change the terms and conditions of the lease anniversary date for purposes of payment of annualrental. 9. Overriding royalty, payment out of production or other similar types of transfers must be med with BLM, but will be accepted for record purposes only. No offi- cial approval will be given. ROUTINE USES: (1) The adjudication of the assignee's rights to the land or resources. (2) Docwnentation forpublic infonnatim in support of notations made m land status, records for the management, disposal, and use of public lands and resources. (3) Transferto appropriateFedernl agencies when concurrence is required prior to granting a right in public lands or resources. (4) (5)Infonnationfiom the record and/or the record will be transferred to appropri- ate Fedeml, State, local or foreign agencies, when relevant to civil, criminal or regula- tory investigations or prosecutions. EFFECT OF NOT PROVIDING INFORMA TION- If all requested informa- tion is not provided, the assignment may notbe approved. See regulationsat 43 CFR Groups 3100 and 3200. Land Description Percent of Interest Percent of Additional space on page 3, ¡fneeded. Do not submit documents or agreements Owned Conveyed Retained O,-:er~idinfn Royalty other than tlús fonn; such documents or agreements shall only be referenced herein. Similar nterests Reserved Previously reserved or conveyed a b c d e f t (Foml3000-3, page3) ~:;;::::::2*t:::*:r ,',1,1.",' i'j'. ,'¡'.: 'I!.&:..!Ò!..t~,Ò~I~ -:', ;im~m;~f:ir; ',,',~, ~~¡~b'i~j:1J,:>'" ':'~'.' 'J,: ':O::~~'~;,:~~':':';¡~¡~<;; ".:1'\,1' . ·,':i ,~'\.~''';''- '.'Ò'j~'~~I·'~"·"" ,_-':·;~:;¡'~_;.~"'i~;";':.'~i;.¡':·,:'~·:~,~, \";"',::i',l~~~,':"-Y '\, " ~ :'>,';;¡'': . -,...- "::1~::;:-' ~ "];5 "39 09.1." . ~.. w S ~ ~ >- ;:: II> ~ Z Z Z .J .J .J 0 0 0 ::> u u u 0 z z z u ::; ::; ::; II> :5 8 :5 w ex: g d d u g t;j « Ñ ~ >- ~ ;:: z Z .J .J 0 0 u u z z ::; ::; ~ '" N '" .; N N N ... .. 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