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Home My WebLink About928598 Ooo~as Form 3000-3 UNITED STATES (May 2006) DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES Mineral Leasing Act of 1920 (30 V.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C 351-359) Geothennal Steam Act of 1970 (30 V.S.C. 1001 -1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 V.S.C. 6508) Type or print plainly in ink and sign in ink. . * QA'!t\ ~IL.'( í\\t!~ í PART A: ASSIGNMENT 1. ~ 6 Eo ('(6 {x J i I..-\.- DA-II\ ~ni\ÙS f~( '.,., city, Stale, ZipCode 3 S'1 ~ eG'-!c f;p~INGS c?Dk() 10. Assignor <rEO r\Gt k' J ( (... ~ DId K. t.--t\ rk'-f v-trE ~,þ. QYSf1 *If more than one œsignee, díeckhde and list 1he name(s) and address(es) of all addtional assignees on page 2 of this Jìnn or on a separate attached sheet of paper. FORM APPROVED OMB NO. l004-<XB4 Exprres: April 30,2009 Leas~Serial ~o.,., 1 " \C- O'L"'::1 I /./ Lease Effective Date (Anniversary Date) New Serial No. - This record tide assigomœt is fur: (Œeck one) rOil and Gas ~ Interest conveyed: (Check one Qr both. as appropriate) Record TItle, GeoIhennal Lease ~_."'-""'of""""",,,m__~ or payments _-------- 2. This assignment amveys the fullowiog interest: \C Land Description Percent of Interest Percent of Additional space on page 2, if needed Do not submit documents or agreements 0wn00 Cœveyed RetaiooI Overridin£ Royalty other than this form; such documents or agreements shall only be referenced herein. Similar terests &:saved Previously reserved or conveyed a b c d e f I,\!~\-\·\r ~~ NoRT« I RNJ6\:: ¡U uJ(,~'f 3('2. 51ø .31¿.s-"1. s-c¿'\Ù' tJ ~ - t.-ð -çs (, Þ, 1, S I '1, \0 -IN Yz. ~ e- RECEIVED 4/20/2007 at 10:41 AM RECEIVING # 928598 BOOK: 655 PAGE: 185 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY FOR BLM USE ONLY - DO NOT WRITE BELOW THIS UNE UNITED STATES OF AMERICA This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or equitable 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 Bureau ofLand Management (BLM) (Continued on page 2) (Title) (Date) u~~~:)~o 000:186 Part A (Continued): ADDITIONAL SPACE for names and addresses of additional assignees in Item No.1, if needed, or for Land Description in Item No.2, if needed. PART B - CERTIFICATION AND REQUEST FOR APPROVAL 1. 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 COIJIOfBtion organized under the laws of the United States or of any State or territory thereof. For the assignment of NPR -A leases, assignee is a citizen, national, or resident alien of the 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 ofthe State in which the lands covered by this assignment are located; (c) Assignee'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 anyone State if this is a geothermal lease; (d) All parties holding an 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 by sec. 17(g) of the Mineral Leasing Act; and(f) Assignee is not in violation of sec. 41 of the Mineral Leasing Act. 3. Assignee's signature to this assignment constitutes acceptance of all applicable \elms, conditions, stipulations and restrictions pertaining to the lease described herån. For geothermal assignments, 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 assignment is added to all previously created overriding royalties (43 CFR 3241). I certify that the statements made herein by me are true, c:omplete, and conect to the best of my knowledge and belief and are made in good faith. Executed this , '2--- day of kFRlv 20~ Executed this r 'L-- day of ~pt\\ l, 2001 Assignor or Attorney-in-raet ~ ' (Si~ ~ ~ ~lfð jfr\ ¡¡..6S ~OA\) f _ (Assignor's Address) Ot LI (" LU vÞ<f~~f\\É C!J< ~ (CIty) (State) (Zip Code) as shown on current lease Assignee J--tL-!.0-t..- SEE ATTACHED NOTARY FORM Title 18 U .S.C. Sec. I 00 I makes it a aime for any person knowingly and wilIfitlly to make to .y Department or agency of the United States any false, fictitious, or fraudulent statements or rq¡resentations as to any matter within its jurisdictioo. (Continued on page 3) (Form 3000-3, page 2) 0928598. CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT Of' - .,,,<:-~-:,<,,: ,(., ~-- ". '-(i"- ,'·=-·;.A&<:.~"\:'¡;~;¡:Œ.)Æ~~ÆKYÆX';ÇÇ,(X:~~~£ç-æx~:;Ð.::;.,""X.;ë(',;¡x~,<6";;"X"":(.K~Ç"íë<4.'i'{~')..;~ ~ . ' .1 000187 State of California }~ I' ~ÃLt1' C~ I" County of f·, on~.~ Date ~ J,.ol) l' LIZc¿ S. QU'€âo.da,tJrJTffI<y pu!Ji~è Nama and 11111 of Offlca, (I,g.. 'Janl Dol, Notary Public1 (.. if personally appeared I' ~ I'. I I' [i personally known to me ~proved to me on the basis of satisfactory evidence . ~"..., to be the person~ whose name IS re subscribed to the Withiri' stru ent and acknowledged to me t~~~ h~ '~l<ey executed the same in 1Tí~t eir . ~lj!Q~~ized capacity(ies), and that by ~H1'éir signature(s) on the instrument the perso~ or the entity upon behalf of which the perso~ acted, executed the instrument. I' ~ LlZA S. QUESADA -. -" CommissIon # 1680127 ¡ . M"; . 'It Notary Public· California ~ , Contra Costa County My Camm. ExpIres Aug 6, 2010 . I, f,. " I' r, f'. I' ~. OPTIONAL Though /he infonnation below is not required by law. it may prove valuabte to persons retying on the document and could prevent fraudulent removal and reattachment of this fonn to another document. r I' ~ 1 I, Description of Attached Document TItle or Type of Document: ~-I\ ~ ~~ ' , ~. umbeco! Pag": ~ iW_ ~ I v1t Il.o.-l ~«' Oll-.~,q~ v, Cju..fk~ ~ Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer Signer's Name: WÁì r q ì 0.... Ji) I DA-t~ í ¡, " I' I, o Individual o Corporate Officer - TItle(s): o Partner - 0 Limited 0 General o Attorney-in-Fact ~ Trustee o Guardian or Conservator o Other: SignerISRepreSenting:~L ~ 1?t~ . .' Top of thumb here ~ r, I, " I' I' . '. ... . '. = C 1999 Nallonll Notary Associlllon' 9350 01 Solo AVI.. :.0. Box 2402' Chltsworth. CII 91313-2402' www.nallonalnotary.org Prod. No. 5907 Rlordlr. Call Tol~Fr.. 1·8011-876-6827 . , 1 ,~ '. , , .' 'j "I < .j ,I , 1 ~ ,I I ,~ , ~ , 'J < .1 'j ,I :1 , ~ .1 , , ~ .'1 : ~ , 'J