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Home My WebLink About928599 Form 3000-3 (May 2006) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A lEASE FOR Oil AND GAS OR GEOTHERMAL RESOURCES 0001 FORM APPROVED OMB NO. 1004-0034 Expires: April 30, 2009 LW~erir!Ò Lf Ss Lease Effective Date (Anniversary Date) Mineral Leasing Act of 1920 (30 V.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 V.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) New Serial No. Type or print plainly in ink and sign in ink. 1. ASgooe* ~ld ~Gf~\t1'Ó~$(~rr A: ASSIGNMENT , S1reet 3'''1 ç E.c-l+D .5PRIt,JbS R~ k D . c ~ J Ù A-( f'. City, Stak:, Zip Code V k fk £ 1\ e . c." tt ~ 6" '11 ,1a. Assignor 6 ( D K G I þ.. I LA... " .If 111m: than one assignee, d1eck 'f.; am Jio¡t the name(s) and addres5(es) of all addtiœaI assignees m XIßC 2 of1lœ tam IX" m a sqøaIe aIIached sheet of pIX2". This record titleassignmem is for: (Checkone) ~ GeothennaI Lease ~ ---- _1'" G~-'''-''''-~-''''-''' ~ InIatst cmveyed: (Check one or both, af Df¥I¥iaIe) 2. This assignment cœveys the following in1aest: Land DescrWtlon Percent of Interest Percent of Additional space on page 2, if needed. Do not submit documents or agreements 0wnaI CaM:yed ReIaioed Ov.en:idin¡f¡ Royalty other than this fonn; such documents or agreements shall only be refen:nced hen:in. SImilar terests Rœcrved Previously m;erved or conveyed a b c d e f -rDujNs~ir 2" N {) t\ 11--1 RM,J6E tí" oJ 1315"(. , ~15 %' ~ . , ~eL-'nON S' E. t.- S ê;"Zf- RECEIVED 4/20/2007 at 10:42 AM RECEIVING # 928599 BOOK: 655 PAGE: 188 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY FOR BlM USE ONLY . DO NOT WRITE BELOW THIS UNE UNITED STATES OF AMERICA Tbis lSSigDmeDt is approved solely for admiDistrative PIll'JlOSi'& Approval does Dot warrlDt that either party to tü IlSÏplleat holdslepI or eqlÚtlble title to tbis lease. . Assignment approved for above described lands; Assignment approved for attached land description Assignment approved effective Assignment approved fur land description indicated on revme of this funn By BW'C8U of Land Management (BLM) (Continued on page 2) (Tille) (Date) u::J,.;,d599 0001.8;7 Part A (Continued): ADDITIONAL SPACE for names and addresses of additional assignees in Item No.1, ifneeded, 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 helshe 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 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, iftbis is an oil and gas lease issued in accordance with the Mineral Leasing Act of 1920, or 51,200 acres in anyone State iftbis is a geotbermallease; (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 terms, conditions, stipulations and restrictions pertaining to the lease described henin. For geothermal assignments, an overriding royalty may not be less than one-fourth (114) of one percent of the value of output, nor greater than SO 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 {'v A...- day of f\f'R( V 20~ Executed this I ~ day of kPf?(V 20Ql as shown on cmrent lease 6€oRcS(k ,} (LL/ . ~\ (Signature) f)1\(fZ ~-~~ . . ""'- -j'i _ ~^-(4Lj ÎU-~ or C (Signa e) Attorney-in-fact (Signature) Assignor or Attorney-in- t ,~ç ~5' fc+lö Sf'é\tN~~gna~b~D I 'P\ ~ "f(': (Assignor's Address) V 'k~C\\"t: CA (City) (State) .q \f-ç~ j (Zip Code) f= SEE ATTACHED ~ iJlse Tide 18 U.S.C. Sec.IOOI makes it a crime for any person knowingly and willfully to make to any Department or agen\:)' ofthf U ftaudulent statements or representations as to any matter within its jurisdiction. '--- (Continued on page 3) (Form 3000-3, page 2) 0928599 0002.90 CALIFORNIA ALL·PURPOSE ACKNOWLEDGMENT '{' - ." ",<:>"X:r ..', ,(:., 'i-0'. ".. ·'<"'--(.··~·;:;€:<,:~~'¡;x~)Æ:{,~.&~{X',Æ'(.~~~:;eç£\':£;<X>i~~;''';:(,;ë('WX;(x'~<V;X:''':<ië(·æ<>Á'5:".:Ð-.;::¡f , '. r ..1 State of California }ss t, ~, County of ~~. C~ M Þòò 1- O· (1--- 'T n \ --,.. . Dale ~, before me, L IZQ.¡ S. 4ltt'S'M4 tJrJrnR. ' PUÞ¡~è '£/Iv ~ \, f (. J fi, personally appeared 1-- -. -- -. .... ~;S.~U;sÄÖA'" -. r 1 ~. Commission # 1680127 r ~ .... Notary Public . California ~ Contra Costa County My Comm. expires Aug 6, 2010 ~personally known to me ~'proved to me on the basis of satisfactory evidence to be the perso~ whose name~ subscribed to the within "instrument and acknowledged to me that h s e/ ey executed the same in hi er/ Ir. a~~rized capacity(ies), and that by ~tl;w(¡r signature(s) on the instrument the person~ or the entity upon behalf of which the perso~ acted, executed the instrument. I'. fi " j. If I, I· I' ~, i, t· ~ . OPTIONAL Though the information below is not required by law. it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document TitleOrTypeOfDo~ument.~(. . ~~ ~ . Document Date: ~ () Numb~.9.f J:ages: ~I\V~ ~- ~~~ Signer(s) Other Than Named Above: ~..w-' VÑA ~ 0'\\ ~~ ~ ~cir\kA"~ ~~~~. .'~ 1 .fi, t J, I I Capacity(ies) Claimed by Signer Signer's Name: ~.e~ ~ ::Ii \ \ ~ tl... \ o Individual o Corporate Officer - Title(s): o Partner - 0 Limited 0 General o Attorney-in-Fact ¡QI'Trustee L{JGuardian or Conservator o Other: Signer Is Representing: .~~ { , .- Top ollhumb here I' ~~T~~ . . -" . ".. ... ~ ~ .. C 1999 National NolaIy Associa"on - 9350 Do SOlo Avo.. P.O. Box 2402 - Chollworth. CA 91313·2402' www.naliDnolnDlary.org Prod. No, 5907 Aoordor. Call Tol~Fr,," 1·800-876-6827 .1 I ,~ .1 .j ,I ~ I --I .J ,~ , . ~ ,I .1 1 < .-1 .1 ,~ ,~ .j ~ .'J . I 'J ·1 :1 , ~ . ~ ,I , ~