HomeMy WebLinkAbout924704
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· "\\t nnt\\\U~ .
n~\:J\\ Of \\ÎI~"~Û(\I\(\n ASSIGNMENT OF RECORD TITLE INTEREST IN A
'~U Qr \.~"~ LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
, 3~ '35
1~ OC1 -'-' ~~ Mineral Leasing Actof1920 (30U.S.C. 181 etseq.)
, 'E. 0 Act for Acquired lands of 1947 (30 U.S.C. 351-359)
R E C £ \\1 nM\ttG Geothennal Steam Act of1970 (30 U.S.C. 1001-1025)
£.tn~£.. ~'( VOèpamnent of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Type or print plainly In Ink and sign In Ink.
DE~NT OF-THE INTERIOR
BUR. OF LAND MANAGEMENT
.
OMB·NO. 1004-0034- 000162
Expires: December 31, 200 I
Lease Serial No.
See Exhibit "A" attached
,
Lease Effective Date
(Anniversary Date)
See Exhibit "AU attached
New Lease Serial No.
PART A: ASSIGNMENT
...
Au1en-·
Street
City, State, ZIP Code
Southwestern Energy Production Company
2350 ~. Sam Houston Parkway East, Suite 300
Houston, TX 77032
.If more than one assignee, check here
separate attached sheet of paper.
o and list the name(s) and addressees) ofall aditional assignees on the reverse of this fonn or on a
This record title assignment is for: (Check one) [K] Oil and Gas Lease, or
Interest conveyed: (Check one or both, as appropriate) ŒJ Record Title,
o Geothennal Lease
o Overriding Royalty, payment out of production or other similiar
interests or payments
f This assi
Owned
Percent ofInterest
Conveyed Retained
a
b
c d
Percent of
Oveniding Royalty
or Similiar Interests
Reserved Previously
reserved
or conveyed
e f
See Exhibit "A" attached hereto and made a part hereof.
RECEIVED 11/22/2006 at 11 :07 AM
RECEIVING # 924704
BOOK: 641 PAGE: 162
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
See Exhibit "A" attached'
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ORIGINAL DO~MENT
IN FILE u ')- / :.3 os-I
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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 assignement holds legal or
equitable title to this lease.
~Signment approved for attached land description
o Assignment approved for land description indicated on reverse
of this fonn.
LAND LAW EXAMiNEfl DEC 0 6 2004
('Title)
(Date)
Blanket
TBI· Savannah (WY 126)
(Hoback)
ORIGINAL '.'
~< .t
':. ".~'" ~ .. .'~
Part A(Continued):
..~~...JNALSPACE for Names and addresses of additional a." ¡II"". In Item No. I. ¡fneeded. or for Land Description in Item NO. ¿ It
needed.
OIL),·· 'I'I'·U ~ '
; J";'·ft'¡ '.J·:t
000163
STATE OF COLORADO
COUNTY OF DENVER
~
The foregoing Instrument was acknowledged before me this d£ day of September, 2004 by Don E. Schroeder,
Attorney-In-Fact for Tom Brown, Inc., on behalf of said corporation.
. WITNESS f"Y hand and official seal.
My commission expires:
STATEOF...~~ ~
COUNTY OF ~^ '" ~ ~ __
~
The foregoing Instrument was acknowledged before me thl~ day of ~ .9-<..1'0,..2004 by Jim Dewbre,
Vice President, Land for Southwestern Energy Production Company, on behalf of sal corporation.
MONA L. SINION
NOTARY PUBLIC
STATE OF COLORADO
My Commission Expires 11/26/2005
WITNESS my hand and official seal.
My commission expires:
." "'.
(S'~~~"~f~;~ KRISTA M. PAUL
! : i Notary Public. State of Texas
~~...,{~ My Commission Expires
''í,f,t,:"~,,, April 16, 2008
~.~ ~~,\)
. Notary Public
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
I. 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 ·spetilied above.
2. Assignee eertifies as follows: <a) Assignee is a citizen of the United StaleS; an association of such citizens; a mwticipality¡ or a corpoÌation organized under d1C~ 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 ofthe Ur.!ted 3tates or associations of such
citizens, nationals, resident ali_ 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) Auipee's c:bargeable interests, direct and indirect, in each public domain and acquired lands separately in the·same State. do not eltceed 246.080
acres in oil and pi 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 of 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 SI.2oo aerea in anyone State if this is a geothermal lease;
(d) All partics holding an interest in the assignment arè otherwise in compliance with the regulations (43 CPR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in
complance 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 Lcuing Act.
3. Assignee's signature to this usigmnent constitutes acceptance of all applicable terms. conditions. stipulations and restrictions pertaining to the lease described herein.
For ¡eothermal usi pIIMDlS, ID cwaridinlroyalty may not be leu ibID one-fourth ('4) of ooe percent of the value of output, oaY areater thlD SO percent of the nte of royalty due to the Uolted Slates wben
this wi pIIMDt is added to all pnviausly created overridinlroyalties (43 CFR 3241).
I certify that the statemeDts made herein by me are true. complete. and correct to the best of my knowledge and belief and are made in gooc1 faith.
¿1r1¡YOf
Assignor
or
Assignee
or
.20~
Executed this ~ g. ~ day of September
but made effective fer eH purposes as of October 1, 2004.
Name of Assignor as shown on cuncnt lease Tom Brown, Inc.
Please type or print
,20 04
Executed·this
Jim
Attorney-in-fact
Tom Brown,lnc~ t I ~
Don.E. Schroeder, Attorney~n-Fact (Signature)
55517th Street, Suite 1850
(Assignor's Address)
Colorado
(State)
~
Attorney-in-fact
(Signature)
Denver
(City)
80202
(Zip Code)
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,fonn. Direct comments regarding the burden estimate or any other aspect of this form to U. S. Depamnent ofthe Interior. Bureau of Land Management (1004-0034), Bureau
Clearance Officer. (W()"~O~. Mail Stop 401 LS. 1849 C Street. N.W., Washington;D. C. 20240.
Title 18 U.S.C. See. 1001 makes it a crime for any person knowingly and willfully to make to any Depamnent or agency of the United States any false. fictitious or fraudulent statements or
'. representations as to any matter within its jurisdiction.
jFo~3000-3 (J.499) (page 2)
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