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Home My WebLink About928597 .. Form 3000-3 (May 2006) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD MLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES FORM APPROVED OMB NO. 1004-0034 Expires: April 30, 2009 Lease Serial N0'1 .1 E- 01.,1' If, Lease Effi:ctive Date (Anniversary Date) Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C 351-359) Geothennal Steam Act of 1910 (30 U.S.C. 1001-1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) New Serial No. Type or print plainly in ink and sign in ink. Qþ(H~ fKtAl~"I1.RùSl PARTA:ASSIGNMENT 1. Asiignee*6[ð~6(.~ JIL,uD^,1? "fRù$lel¿ Street 3 -5 y.¡j (~ ~ft\~? RokO ') D v City, Slate, Zip~..Æ'¿ oIC.1n la. Assignor G ec f\ G r", .J l u....- ( k b, vkfl\Ve \\ {.;,CP\' '1"1',')'11 -If rom: than œc assignee, clJeck hen: anllist Ihc IIIJIe(s) anllllldn:æ(œ) of all addIiœal øssignees m page 2 oftIœ fiJm Œ m aSCJlKåe atIaI:hed sheet of pIJŒ. Thisrecoollitle æsignmentis fur. (Checkone) 0 mxI ~, oc InIa'est ameyed: (Check one 01' both, aJ t1J1JXVJ7iafe) RamI Title, GeahennaI Lea'iC (5_._..."_Œ_.....~ Œpayments _ 2. This æsigoment conveys Ihc following interest Land Descriotion Percent of Interest Percent of Additional space on page 2, if needed. Do not submit documents or agreements Owned Cmveyed Retained Ov.e~din£ Royalty other than this form; such documents or agreements shall only be referenced herein. Similar terests Ri:saved Previously resaved or conveyed a b c d e f --(ðU.lNSI~p Z1 NOf\f~ RKNG( (l3 .S-Yo _ 5 v/" S~1IDt120 .- ses,", SV\lst tl' 5~e '32.-- .5-\,Se. N~~e ~~,.,¡~~ , I ' :3~' !'H'~Ne. 0'~~e Sé NV\J ( , I lOuJN~H(P 2& ND~íl1- I Rt\NG( 113 ulttí"" ~~J~N 't- (,-$ís r-IL.,,$fl ~w5lN FOR BLM USE ONLY - DO NOT WRITE BELOW THIS UNE UNITED STATES OF AMERICA This usignment is Ipproved solely ilr Idministrltive purposes. AppJ'OVll does DOt Wlrrut tblt eitIIer I'IlIty to dlis usipmeat holds lepl or eq_ble title to this lease. Assignment approved for above described lands; Assignment approved for attached land description Assignment approved effective Assignment approved for land description indicated on reverse of this form By Bun:au of Land Management (BLM) (Continued on page 2) (Title) (Date) RECEIVED 4/20/2007 at 10:40 AM RECEIVING # 928597 BOOK: 655 PAGE: 182 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Part A (Continued): ADDITIONAL SPACE for names and addresses of additional assignees in Item No.1, if needed, or for LlIDd Description in Item No.2, if needed. OS2SS9? . OOosea PART B - CERTIFICATION AND REQUEST FOR APPROVAL I. 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. 2. 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 the 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 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 IIDd indirect, in each public domain and acquired lands separately in the same State, do '.lot exceed 246,080 acres in oilllDd gas leases (of which up to 200,000 acres may be Ì1 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 State if this is a geothermal lease; (d) All parties holding lID 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 bysec. 17(g) of the Mineral Leasing Act; and (f) Assignee is not Ì1 violation of sec. 41 of the Mineral Leasing Act 3. Assignee's signature to this assignment constitutes acceptance ofall applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein. For geothermal assignments, 1111 overriding royalty may not be less than one-fourth (114) 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). 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 ~ day of J<ft\ I V 20 D 1 Executed this (¿" day of A f'RI V 20 .Q..L Name of Assignor as shown on current lease G ee> t\ cð ( _11 L-,'v Assignor ~"'\~~ A ~'-- ~~ or / _ (Signature) Attorney-in-fact . ...- . (Signatuft:)., JSC1.ç' eC~(' ~f'RI NGS Kòf\Ç) (Assignor's Address) ~ þ( r- Ä'( ( \te C k cp.{-ob l{j (City) (State) (Zip Code) or print) . . ê5'<þ ~ 'Í~~ (Signature) Assignee or Attorney-in-fact SEE ATTACHED NOTARY FORM Title 18 U.S.C. Sec. 1 001 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 1ìaudulent statements or representations as to any matter within its jurisdiction. (Continued on page 3) (Form 3000-3, page 2) 092859'1 000184 CALIFORNIA ALL·PURPOSE ACKNOWLEDGMENT .-~,;€f.~~'ð::;'::>'i&.)£;,('~'(~'\Y,6(.'XX>Æ'(.~1~:æç£¡:,æ<*-'i;~:;"";;(,;!t(.':.;[X'::C<:;£.çÆ(^'''X':(~>Ã'5'''~~~ I State of California ~ ' I,. 6rnXLt1. CfYLTlt A ,,_. }ss LJZQ.¡ S, 4)U'€S-M4 ¡jrJTltR. . puÞM:_ , Namo and TIllo 01 omcor (o,g.. 'Jano Doo. Nolary Public1 Aut, Name(o)'ol 5ill('o'(5) o personally known to me % proved to me on the basis of satisfactory evidence to be the person~, whose name~Àa.fe- subscribed to the within instrurr;-~and acknowledged to me that h~'e~1:w!ý executed the same in h~eJtf¡¿¡fr authorized capacity(ies), and t'ñãí by hi(1Iìerßherr signature(s) on the instrument the per~ or the entity upon behalf of which the perso~ acted, executed the instrument. ." OPTIONAL Though Ihe information below is nol required by law. II may prove valuable to persons relying on the document and could prevent fraudulent removal and reallachment of this form 10 anolher document. o Individual o Corporate Officer - Title(s): o Partner - 0 Limited 0 General ~ g;~ttorney-in.Fact ~rustee C Guardian ~Çons~"r C Other: ~ ~ Signer Is Representing: VA-I (l.. PA--f\.1/L. '/ 7l~ CVrv;( County of ff on~~l I~( ..20è 7 before me, personally appeare:'o (j~-rg k; J;}) , , ,. Top ollhumo nere ."- ..'. .. = ~. . f.- I ~ 1-, j I' ~--~~--~~~~~-~ ~' . LlZA S. QUESADA . -'. , Commission # 1680127 ~ .... . I Notary Public - California ~ " - Contra Costa County My Comm. Expires Aug 6, 2010 = C 1 ggg National Nolaoy Associallon . 9350 00 Solo Avo.. ~.O. Box 2402 . Chal5wo~h_ CA 9 1313·2402 . www.nalìonalnotary.O<g ¡! I' I, I· (, ~, " I' ~ , Description of Attached Document Titl. oi T YPÐ of Docum~ .!j~J-ïJí:. CA7' .m Document Date: / 0 ;:¡ Signer(s) Other Than Named Above: ( ,~, t' I ~ Capacity(ies) Claimed by Signer , Signer's Name: G~èA Jfl/ 1JA--ttC ¡. Prod. No. 5907 Reordor. Call Tol~F",o .Iloo.ð76·6827 ,J' 1 } } 'j , ,~ ,I , )~ .j 'I 'J ! '. 'ij '1 . I I ,I , I ,~ ,ij .j j .j , . I , ~ ,I , , ~ 1 ~ ,I . ~ 'I ,