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Home My WebLink About875953 l~ohn 300q:3a 'UNITED STATES (January 1996) DEPARTMENT OF THE INTElidOR FORM APPROVED DMB NO. 1004-0034 BUREAU OF LAND MANAGEMENT Expires: September 30, 1998 TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A Lease Serial No. LEASE FOR OIL AND GAS OR GEOTHER[i/IAL RESOURCES WYW-138553 I e, l et seq.) Mineral Leasing Act of 1920 (30 U.S.C. ' Act for Acquired Lands of 1947 (30 U.S.C,. 351-359) Geothermal Steam Act of 1970 (30 U.S.C. i'5:)01-1025) Department of the Interior Appropriations Act, Fiscal Ye::X 1981 (42 U.S.C. 6508) Type or print plainly in ink and si.eli!! in ink. PART A: TRANSFER 1. Transferee (Sublessee)* INTREPID OIL & GAS, LLC 34.65% Opera!!i.~g Rights Street 1801 BROADWAY, SUITE 800 City, State, ZIP Code DENVER, CO 80202 Ii *Ir'more than one transferee, check here IX and list the name(s) and address(es) of all additio~;¢ transfe[ees ~on the reverse of this form or on a separate attached sheet of paper. This transfer is for: (Check one) [] Oil and Gas Lease, or [] Geothermal Lease Interest conveyed: (Check one or both, as appropriate) [] Operating Rights (sublease) [] Ow~:rriding Royalty, pa.vment out of production or other similai' interests or payments 2. This transfer (sublease) conveys the following interest: Land Description Fercent of Interest Percent of Additional space on reverse, if needed. DO not submit documents or agreements other than Owned Conveyed Retained : . Overriding Royalty this form; such documents or agreements shall only be referenced herein, or Similar Interest ResPa, ed Previously or conveyed a b ;.~ c d e f INSOFAR AND ONLY INSOFAR AS SAID LEASE COVERS: 70.00%: 70.00% None None As of Record Township 23 North, Range 114 West, 6t~ P.M. Section 10: All Intrev~i] 34.65% Emerajd 34.65% Containing 640.00 acres, more or less ' Donzili 0.70% Lincoln County, Wyoming ~.. Limited from the surface ofthe earth to the stratigraphic equivalent of 12981' as in the Dual Induction-SFL electric log bom the Exxon Company USA Graham Reservoir Unit #1. Located in the SW/4SW/4 of Section 36, T23N-R114W, Lincoln County, Wyoming ' Acreage Purchase Letter dated May 1, 1998, by and between Tom Brown, ~, i~ Inc. and Mission Oil Corporation et al. 8 '7 5 9 5 3 i' [ (}i FOR ELM USE ONLY-DO NOT'WRITE BELOW THIS LINE THE UNITED STATES OF AMERi'C):: This transfer is approved, solely for administrative purposes. Approval does not warrant ~:hat either party to this transfer holds legal or equitable title to this lease, [] Transfer approved effective By (Authorized Officer) :. (Title) (Date) Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional transferees in Item I'i;'o. i: if needed, or for Land Description in Item No. 2 if needed. EMERALD RESOURCES, INC. 34.65% 934 South Fillmore'Way Denver, CO 80209 TERRY W. DONZE 0.70% 4048 Simms Street Wheatridge, CO 80033 PART B: CERTIFICATION AND REQUEST FOR APPROVAL 1. The transferor certifies as owner of an interest in the above designated lease that he/she hereby transfers 'i? the above transferee(s) the rights specified above. 2. Transferee certifies as follows: (a) Transferee is a citizen of the United States; an association of such c~tizec, s; a municipality; or a corporation organized under the laws of the United States or of any State or territory thereof. For the Iransfer of NPR-A leases, transferee is a citi~m, ~:ational, or resident alien of'the United States or associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Transferee is not con,id~ved a minor under the laws of thc Slate in which the lands covered by this transfer are located; (c) 'l:ransferoe's chargeable interests, direct and indirect, in each public domah~, and acquired lands separately in the same Stale, 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 ~i~zre,: in leases in each leasing Dislxict in Alaska of which up to 200,000 acres may be in options, ffthis is an oil and gas lease issued in accordance with the Mineral Leasing A~!t o~ 1920, or 51,200 acres in any one State ffthis is a geothermal lease; and (d) All parties holding an interest in the Iransfer are otherwise in complianc~ with thc regulations (,~13 CFR Group 3100 or 3200) and the author/zing Acts; (e) Transferee is in compliance with reclamation requirements of all Federal oil and gas hold/rigs as required by sec. 17(1!) of~e Mineral Leasing Act; and (f) Transferee is not in violation of sec. 41 of the Mineral Leasing Act. 3. Transferee's signature to this a~$ignmeni constitutes acceptance of all applicable terms, conditions, stipuiatlm~s and restrictions pertaining to the lease described herein. Applicable terms and conditions include, but are not limited to, an obligation to conduct all operations o~! the; leasehold in accordance with the terms and conditions of the lease, to condition all wells for pmpor abandonment, to restore the leased lands upon completion of~my .~perations as described in the lease, and to fumlsh and maintain such bond as may be requin:d by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206. For geothermal mmsfers, an ovenSding royalty may not be less than one-fourth (I/4) of one percent of the valm:'ofoutput, nor g~.ater than 50 percent of the rate of royalty due to th ,..U..nited States when this transfer is added to all previously created overridin[[ royalties (43 CFR 3241). I certifiy that the .statements made herein by me are true, complete' and correct to the best of my knowledge ~ind belief and are made in good faith. Ex~,urted this ~.~.'~ ,",_~, day of J~Y ,2001 Executed ~s /~. -r ~, day of ~ ,2601' Name of Transferor ~. TOM BROWN, INC. INTI~,;PID OIL & GAS, LLC Please type or print Transferor Trangfer,~ ,/'~/ .t .,~ · '-1271' x ' ~(Signature) ~ ' . Denver , CO 80202 . e ultz, Vice Presid~nt-,, Public reporting burden for this form is estimated to average 30 minutes per response, including the time fo~:',reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direc! comments regarding the burden estimate or any other aspect of:12~is :lbrm to U.S. Department ofthe Inlerior, Bureau of Land Management, Bureau Clearance Officer, (DW-110), Denver Federal Center, Building 40, PD. Box 25047 !Der vet, CO 802254}047 and the Office *fManagement and Budget, Pa_~pe~vork Redu.c. tion Prq}ect (1004-0034)~ Waqhln~ton, D.C. 20503 Till.e 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfullF to make to any Departm.mt 0r agency of the United Sta'tes any false, fictitious or fi'audulent · 01~:5~53 /kCKNOWLEDGEMENT :, 288 STATE OF COLORADO ' i) CITY AND COUNTY OF DENVEk) On the ..q%-,;k. dayof ?'3¥ ,2001, personally appeared before me Rodney O. Mellott , who !~eing by me duly sworn did say that he is the Vice ?,resident - Land for Tom Brown, In~:.)i and is authorized to execute this assignment. Witness my hand and* official seal. : !~ .~-. . ..... My CommissionExpires: ~4~y ll:_2005 , ' ~ -~ · Address: 555 17 Street, Stately... ~enwz, ~..~ ou~.v,~ STATE OF CoLoRADo " ) CITY AND COUNTY OF DENV!:!~:R) On the ,:': '2J4k day of 51::::!t0 ~/3ql~/~"'/~ , 2001, personally appeared before me Robert P. Jornayvaz III who being t:;y me duly sworn did say that he is the Attorney-in-Fact for Intrepid'Oil & Gas, LLC, ~d is aul'horized to execute this assignment. Witness my hand and offic[!)i seal. My Comn~.,~,~.pires: _9/28/01 : .FU¢ ~' - .<,'~ .c,~...' .... :, ...~w}~\-:~.''~.0~ y& Address: 1801 Broadway, Suite 800 .~ '~'..' .¢.O';ARp '.? ¢ ,, Denver, CO 80202 ACKNOWLEDGEMENT STATE OF COLORADO ) CITY & COUNTY OF DENVER ) On the day of ,2001, personally appeared before me Maureen S. Schultz, who being by me duly gwori~ did say that she is the Vice President for Emerald Resources, Inc. and is authorized to execute this assi;gntnent. Witness my hand and offici~ ! ~: x~u'""r '~ ~ Notary Public ~,~ ~ ' " Address: 1801 Broadway, Suite800 : Denver, CO 80202 STATE OF COLO~O ) CITY & COUNTY OF DEN~R ) On the /'~[%day of--~ ~"'~--- ,2001, personally appeared before me Ter~ W. Donze who being by me duly sworn did say'that :~s authorized to execute this assi~ment on his own behalfi Witness my hand and offici~J seal. - Address: 1801 Broadway, Suite 800 ~XCX~II~II//2~/(*~ , Denver, CO 80202