HomeMy WebLinkAbout923762
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Form 3000-3
(October 1992)
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OOÕ281.
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
FORM APPROVED
OMB NO. 1004-0034
Expires: July 31,1995
Lease Serial No
ASSIGNMENT OF RECORD TITLE INTEREST IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
see attached exhibit "A"
Mineral Leasing Act of 1920 (30 D.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 D.S.C. 3.51-3.59)
Geothermal Steam Act of 1970 (30 D.S.C. 1001-102.5)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 D.S.C. 6.508)
Lease Effective Date
10/0112006
1. Assipft*
Street
aty, State. ZIP Cock
Type or print plainly In Ink and sign In ink.
PART A: ASSIGNMENT
Gary-Williams Production CompIIDy
370 17" Stn:ct, Suite 5300
Denver, CO 80202
*H mon than one transferee. check hen I J and list the namc(s) and addrea(cs) of aO additional transfertcl 011 tile nycnc oftlúl forw or o. a øeparate attached
shect ofpapcr.
This transœr is for: (Check one) [X ] Oil and Gas Lease, or [ ] Geotb.Irm. Lease
Interest conveyed: (Ch«k one or both, Q3 appropriate) [X] Record Title. [ ) Overriding RoyIIIty, payment out of procIuction or other
simil... inten:sts or p1IyIIICIIts
2. This assi the fullowing interest:
Land Description Percent of Interest Percent of
Overriding RoyIIIty
Addition. space on reverse, if needed. Do not submit documents or agreements other than this Owned Conveyed Retained Or Simü... inten:sts
funn; such documents or agreements shall only be refen:nced herein. Rcsc:rved Previously
resem:d
or
conveyed
A b c d e f
~ Attached Exhibit "A" 100""" 100% 0% 0% 0%
Lincoln County, Wyoming
-
RECEIVED 1 0/26/2006 at 2:56 PM
RECEIVING # 923762
BOOK: 638 PAGE: 281
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY ,. ..
c. .,
, ! ~.' ~
FOR BLM USE ONLY-DO NOT WRITE BELOW 1BIS LINE
[ ) Assignment approved for above described lands;
Assipment approved effective
TIlE UNITED STATES OF AMERICA
This assignment is approved solely fur administrative purposes. Approval does not wmant that either party to this assignment holds legal or equitable title to this lase.
[ ] AIsip_ent approved for attached land dcscriptloJl
[ ] Alsipment approTed for land dac:ription indicated 011 rnene of'tIds fonn
By
(Authorized Officer)
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Part A (Continued): ADDmONAL SPACE fur Names and addresses ofødditionallSSignees in Item No. I, ifneeded, or fur Land Description in itrm NO.2 ifneeded
ACKNOWl.J:DGMENT
STATE OF COLORADO
COUNTY OF DENVER
82
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MyCommissionExpirfJs:Augustl5,2010 'fla¡Ú. ~
NotIIry Public
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ACKNOWLEDGEMENT
STATE OF COLORADO
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CITY & COUNTY OF DENVER
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The foregoing instrument was acknowledged before me this L day of October, 2006, by Tim Howard, Vice Presi
Gary-Williams Production Company.
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I certify, that the sbib.....m. IIIIIIfe herein by me are true, complete, and corm:t 10 the best ofmy knowledge and beliefand are IIIIIIfe in good fiIiIh.
Ú\L Lpí'f-
~ day of October
GUJ-WQa- ProdKtIoB C-puy
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(SipIIbn) - r... HowonI- v... Pnoideat. SpoåaI Projocts
Û;;¡;¡-S*.dt'is -J!mnem is ~ ~ alí ~Iy creaœd overriding roy¡d~ (43 CFÎl3241).
Execu1ed this
Assignee:
3rd
2006
Execu1ed this
Name of Assignor IS
Assignee:
AssIpor:
Or
Attoney-....I'act
.u.Ipee:
or
Attomey-i.fact
(city)
AttorHy-lll-fact
MyCormisslon Expuu 08f20I2008
2006
(SipoIare)
Public reporting burden fur this funn is estimllted to avenge 30 minutes per response including the lime fur reviewing instructions, galbering and maintaining daIa, and
completing and reviewing the form. Direct comments regarding the burden estimate or any other upect of this form 10 U.S. De¡.-bnad or1be Inœrior, ~ orLand Mmmgrment,
(Alternate) Bureeu Clt8lIIIIœ Officer (W0-77I), 1849 C SIniet. N.W., WlSbingIun, D.C. 20240. and 1be Office ofM~ and BucIgd, I'Bpawork 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 10 make 10 any Depertment or agency of the Uniœd StJdm any false, fictitious or liauduIent statements
or represenlBtions as 10 any IIIIIt1er within its jurisdiction.
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