HomeMy WebLinkAbout876144 Fonn 3000-3a
(January 1996) ~ UNITED STATES
~.. DEPARTMENT OF TIlE INTERIOR FORM APPROVED
BUREAU OF LAND MANAGEMENT OMB NO. 1004-0034
Expires: September 30, 1998
TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A Lease Serial No.
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
MASS ASSIGNMENT
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)
Type or 'print plainly in ink and si~ln in ink.
PART A: TRANSFER
1. Transferee (Sublessee)* 1NTREPID OIL & GAS, LLC
Street 700 17th STREET, SUITE 1700
City, State, ZIP Code Denver, CO 80202
*If more than one transferee, check here [] and list the name(s) and address(es) of all additional transferees 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) [] Overriding Royalty, payment out of production or other similar
interests or payments
2. This transfer (sublease) conveys, the fotlowing~ interest:
Land Description Percent oflnterest Percent of
Additional space on reverse, ifneedexl. Do not submit documents or agreemenls other than Owned Conveyed Retained Overriding Royalty
this form; snch documents or agreements shall only be referenced herein, or Similar Interest
Reserved Previously
reserved
or conveyed
a b c d e f
MASS ASSIGNMENT BOOK 4~'~"7~ PR PAGE
SEE EXHIBIT 'A' ATTACHED HERETO AND MADE A PART
HEREOF
Assignment is subject to the terms and conditions of that Letter
Agreement dated January 14, 1997, by and between Missi~i~
Corporation, Emerald Resources, Inc. and Terry W. Donz~a~d~i§ i [~ 1~ ' "~" '''~"
intended to assign all of the right, title and interest of Terry W. Donze ~} I;22..'~ l.l;~ :' '''~ ~'
FOR BLM USE ONLY-DO NOT WRITE BELOW THIS LINE
THE UNITED STATES OF AMERICA
This transfer is approved solely for administrative purposes. Approval does not warrant that 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 ofadditinnal transferees in Item No. 1, if needed, or for Land Description in Item No. 2 it:needed.
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 to 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 citizens; a municipality; or a corporation organized under the laws of ibc
United States or of any State or territory thereof. For the transfer of NPR-A leases, transferee is a citizen, national, 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 considered a minor under the laws of the State in which the lands covered by
this transfer are located; (c) Transferee'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 any one S late if this is a geothermal lease;
and (d) All parties holding an interest in the transfer arc otherwise in compliance wifu the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Transferee is
in compliance with reclamation requirements of all Federal oil and gas holdings as required by sec. 17(g) of the Mineral Leasing Act' and (f) Transferee is not in violation of sec.
41 of the Mineral Leasing Act. '
3. Transferee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein.
Applicable terms and conditions include, but are not limited to, an obligation to conduct all operations on the leasehold in accordance with the terms and conditions of
the lease, to condition all wells for proper abandonment, to restore the leased lands upon completion of any operations as described in the l'ease, and to furnish and maintain such
bond as may be required by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206.
For geothermal transfers, 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 transfix is added to all previously created overriding royalties (43 CFR 3241).
I certify that the statements made herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Executed this / e.~ 7~--'~' day of ~"~.,,D'y~'.?~,~,,~,/t.?~¢'--: 2001 Executed tiffs ~/~,.~'~'x_ day of ~ .t~~' ,2001
/ -
Name of Transferor ~ . Terry W. Donze ~ .
Pleasfi~f~ or)rint INTREPID OIL & GAS, LLC
Attorney-in-fact Attorney-in-fact ,J('_) ,/~
(Signature) ' ' [ (Si~d~~P. Jomayvaz III
4048 Simms Street
(Transferor's Address)
Whell[ridge CO 80033
(City) (State) (Zip Code)
BURDEN HOURS STATEMENT
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 conunents regarding fire burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land
Management, Bureau Clearance Officer, (DW-110), Denver Federal Center, Building 40, P.O. Box 25047, Denver, CO 80225-0047 and the Office of Management and Budget,
.P. aperwork Reduction Prq,iect (1004-0034), Washinlltorb D.C 20503
Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Depa~ment or agency of the United States any false, fictitious or frauduleut
..s.m. tements or representations as to any matter within itsjurisdiction.
*u.s. GPO: 1990-573-016/260$0
ACKNOWLEDGEMENT
STATE OF COLORADO )
COUNTY OF DENVER )
On the I ay of September, 2001, personally appeared before me Terry W. DOnze who being by me
duly sworn did say that is authorized to execute this assignment on his own behalf.
~ ~ ~ :~g Address: 1801 Broadway, Suite 800
who berg by m'e duly sworn did say that he is the A~omey-in-Fact for Intrepid Oil & Gas~ LLC, and is
authorized to execute this assi~ment,
Wimess my hand and official seal.
.axXX?::"XlIII~I;/?////~ Ad&ess: 1801 Broadway, Suite 800
~O~.'" ...... ~0 ~ Denver, CO 80202