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Home My WebLink About929339 000836 Jor¡n3~'" 1\1\LliìU!~ UNITED STATES . .,._ \;'t~\(~t1"~lli¡~~l;,\\jt.'¡ ',C.. DEPARTMENT OF THE INTERIOR d\J\(,·hu Jr BUREAU OF LAND MANAGEMENT r¡n Hr~R -5 M~ g: OOASSIGNMENT OF RECORD TITLE INTEREST IN A .....1 . .." r~EASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES ,- ; c.U 1_, ¡ IJ Y m.m~ G Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) ,', ¡\ F Y E HH E, V Act for Acquired Lands of 1947 (30 U.S.C 351 - 359) L - Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025) Department ofthe Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) FORM APPROVED OMS NO. 1004- 0034 Expires: October 31, 2004 Lease Serial No. WYW-150504 Lease Eftèctive Date (Anniversary Date) 0510112000 New Serial No. 1. Assignee" Palace Exploration Company Sfræ 6100 South Yale Avenue, Suite 1700 City, State, Zip Code . Tulsa, Oklahoma 74136 *Ifmorethan oneassiguee, dl.:ckhere 0 and œt thenan~s)andaddress(es)ofall addtionalll&'li~ on page 2 oftlùs tÒIß1 or on a separate attachoo sheet of paper. Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT This reconI title assignment is for: (Check one) 0 Oil and Gas Lease, or Interest conveyed: (Check one 01' both as appropriate) [(] Record TItle, D Goothenual Lease D O..enidÛ1g Royalty, paymðlt out of production or other sinúlar interests or payments 2. 11ús &'>Sigmuelú conveys the tòlIowÛ1g interèSt Land Description Percent ofInterest Percent of Additional space on page 3, if needed. Do not submit documents or agreements Û\med Cooveyoo Retained O~en:idin!n Royalty other than this fonn; such documents or agreements shall only be referenced herein. SimIlar nterests ReselVed Previœsly resaved or conveyed a b c d e f ASSIGNOR(s) Condor Exploration, LLC 100/0 9.5% .5% ditTerence Of Record 7720 East Bellevlew, Suite #8-102 between Greeenwood Village. CO 80111 existing burdens Nevada Petrolem Corporation 8% 7.6% .4% and 20%, Of Record 1345 NW Wall Street, Suite 100 thus, Bend, OR 97701 delivering an 80% Horsetrap Partners, LLC 10% 9.5% .5% Net Of Record 2371 Brighton Circle Revenu.. M..dford, OR 97504 Interest. W2 See 17-22N-1I4W, Uncoln County, Wyoming SUBJECT TO THAT CERTAIN FARMOUT AGREEMENT DATED AUGUST 29, 2005 BY AND BETWEEN ASSIGNOR'S AND ASSIGNEE. 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 assignment holds legal or equitahle titlfÞ{hiS lease. 1\ Assigmnent approved for above described lands; D Assigmnent approved for attached land description Assigmnent approved effective AE.R 0 1 2007 0 Assigmnent approved for land description indicated on reverse of this fonn 1St Kelly Roberts By ---tAND JrtAW EXAMINF;R Itle) RECEIVED 5/14/2007 at 1 :36 PM RECEIVING # 929339 BOOK: 657 PAGE: 836 APR 2 6 2007 (Altthorized Officer) (Contil/lIed on page 2) (Date) ..- A ~.....- ,. r A "'II. 1..-1""'\ FOR ASSIGNEE O~~'¡ p,WJI -,~ ---QU ,.' Part A (Continued): ADDITIONAL SPACE for nømes and addresses of additio~al assignees in Item N \r. h if·neede<t:.~:;>:'?,~~~~,..,...·- ; _ ,- __t(~3~j~ I ' , (ìCt.r'IALSFAL' ",t") ¡¡¡~ I 'I" ,,-I' ,-'.- 'Z'IoJ",=", , , !i, N~YCE M LARSEN 'II..J IIJ W ~ ~ ASSIGNORS: (:. f\IOT¡WY P\)F3L1C-OREGQN Ii} ;1J fJ) ~ . .t' ('I ~... fiv COMMi'ò')IIJN NO, 3643ZIH \! en ~ U ~. ~!,! STATE OF OREGON i~ f~lCé)MMI~SI01'¡ E;<PIRFS .IAN. 25 2007 i"j ..J...I :J'Z ;Z'I ~~U:l~:O~:i~~~~~r~:s aCkn~~~~~;9W:~¡~:'~:':¡ ª~ ~ ~ ~f;., 2006, by Patrick M Gislel', Manager of C I' Ex 101'8 ' n, LLC. ~ ~ íI: ~ ¡¡¡ , My commission Exph'es: IJJ'~-ð7 ' , Notary Public <t ~ ~ ð 00- zu~ ~ ::¡¡ o I.) ~. By: STATE OF OREGON COUNTY OF DESCHUTES 111- The foregoing inshument was acknowledged before me this t!!!- day of 2006, by Patlick M Gisler, Agent of Neva e Ie C ration, My commission Expires: IJJ-~-dJ ::~P~TNERS'LLC Phil Andel'Sch, Manager Dated: <- - 'a.. \ -0 -::;-- ~ 1U57r STATE OF OREGON COUNTY OF JACKSON r The fQ!"egoing instl'Ument was acknowledged before me this ~ day of F-è,!,rn/' ~ 2oo~rby Plúl Andersch, Manager of Horset~ar~ers, LLC. My commission Expires: 3-'21' L17 " (;t- ,Notary Public Notal'Y Public PART B - CERTIFICATION AND REQUEST FOR APPROVAL 2:~j 00.. ~,...... Zwco", ~ a:t")... Wo ,: UJ ,0:11 C/)..Juzv. ..JO- ... :! ...JZ~ !::!z~o'" 1tc(a.ëñ~ o»cnse a:a:-~ <C~- f-'~:¡;; 00:& zuB ... :II! 1. The Assignor certifies lIS 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; øn association of such citizens; a municipality; or a cOlporation organized under the laws of the United States or of any State or territory thereof. For the IISsigmnent ofNPR-A leases, assignee is a citizen, national, or resident alien of the United States or association of such citizens, nøtionals, resident aliens or private, public or mwúcipal colporation." (b) Assignee is not considered a minor under the laws of the State in which the lands covered by this assigmnent 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 le88es (of which up to 200,000 acres may he in oil and gas options), or 300,000 acres in le88ea 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 S1,2oo acres in any one State ifthis is a geothennallease; (d) All parties holding an interest in the assigmnent 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 LellSing Act; and (0 Assignee is not in violation of sec. 41 oflbe Mineral Leaaing Act. J 3, Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described here in. For geothennal assigmnents, øn overriding royalty may not be less than one-fourth (1/4) of one percent of the value of output, nor greater than so percent ofthe rate of royalty due to the United States when this IISsignment 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 ~f and are made in6°Od faith. Executed this day of 20 Executed this ~ day of ~ 20 .b¥- Name of Assignor as shown on cUITCnt lease SEE ABOVE Assignor or Attorney-in-fact (SÎlznature) Assignee onCOmplnY (Please type or print) (Signøture) SEEPAGE 1 (Assignor's Address) or Attorney-in- Vice President SEE PAGE 1 (City) (State) (Zip Code) Public reporting burden for this fonn is estimated to avemge 30 minutes per response including the time for reviewing instructions, galllering ønd maintaining data. and completing and reviewing the fonn. Direct comments regarding the burden estimate or any other aapect of lhis fonn to U.S. Department of the Interior, Bureau of Land Manøgement(l004-0034), Bureau Infònnation Collection Clearance Officer, (W0-630), Mail Stop 401 LS. 1849 C Street, N. W., Washington, D.C. 20240. Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency ofthe United States any false, fictitious, or fTaudulent statements or representations as to any matter within its jurisdiction. (Colltillued 011 page 3) (For1ll3000-3, page 2) PART C - GENERAL INSTRUCTIONS UUUB38 I. Assignor/ Assigntt must complele Parts A 1 and A2 and Part B. All parties to assignment must sign as follows: The assignor(s) mllSt manually sign 3 original copies and the assignee(s) must manually sign at least I of the 3 original copies. File three (3) compleled copies of this fonn in lhe proper BLM office for each assignment of record title. For a Iransferof oveniding royalty interesl, payment out of production or other similar inteœst or payment, file on: (I) manually signed copy ofthis fomt. The required filing fee (nonrefundable) must accompany the assignment.FiJe assignment within ninety (90) days after date of execulionof assignor. 2 Separate fomt must be used for each lease being affected by this .....ignment and for each Iype of Ílúerest conveyed. 3. In Item No.2 of Part A, describe lands affecled (See 43 CFR 3106, 3135 or 3241). For columnb. c, II, and e, enler the interest expressed as a percentage of tot a! interest in the lease; e.g., if assignor assigns one quarter of a 20% in- terest, enter 20% in column b, 5% in columnc, and 15%in column d. 4. If assignment is to more than one assignee, enter each assignee's name across TIle Paperwork Reduction Act of 1995 requires us to illfonn you that: 1. This infonnation is being collected pursuant to the law. 2. This information will be used to create and maintain a record of oil and gaslgeothennallease activity. 3. Response to this request is required to obtain benefit. BLM would like you to know that you do not have to respond to this or any other Federal agency sponsored infonnation collection unless it displays a cuirently valid OMB control nwnber. NOTICE The Privacy Act of I 974and the regulation in 43 CFR 2.48(d)providethat you be furnished the followinginfonnationin connection with infonnalion required by this oil and gas/geothennallease record title assignment application. AUTHOmTY: 30U.S.C.181 et seq.; 30 U.S.C.lOOI-1025; 42 U.S.C. 6508 PRlNCIP AL PURPOSE: TIle infonnation is to be used to process record title as- sigmnents for oil and gaslgeothennal resourcts leases. 5. If any payment out of production or similarinleresls, arrangements or payments have previously been created out of the Ílúerest being assigned, or if any such payrnerØ or interestsare resewed mder this assignmelt, include a stalement gMng full details as to amount, method of pøyII\CÒ, and other pertinent tenns as ptmided under 43 CFR 3106, 3135, or 324 L 6. The lease accOlmt must be in good standing before lhis assignment can be ap- proved as provided under 43 CFR 3106and 3241. 7. Assignmen~ if approved, takes effect m the first day of the month following the date offilingin the properBLMofficc. Ifa bond is necessal)', it must be fur- nished prior 10 approval ofthe assignment. 8. Approval of assignment of record title to 10004. of a portion of the leased lands createsøeparate leases of the retainedand the æsignedpor1ÍOI1I, IU does nit cb~ the tenus and conditions of the lease anniversary date for purposes of paymenl of annual rental. 9. Oveniding royalty, payment out of production or other similartype& of transfers mustbe filed with BLM, but will be acceptedforrecord purposes only. No offi- cial approval will be given. ROUTINE USES: (I) The adjudication of the assignee's rights to the land or resources. (2) Thamcøalion furpuliic infunnalion in 5IIpJXIt of mtations I113d= at land stalus, records for the management, dispOllal, and use of public lands and resources. (3) Transferto appropriate Federal agencies when concwrence is reqtired prior to granting a right in public lands or resources. (4) (5)Infonnationftom the teeord and'ortherecordwilllx: transfearedto appropri_ ate Fedend, State, local or fureign agemes, when relevant to civil, criminal or regula- tol)' investigations or prosecutions. EFFECf OF NOT PROVIDINGlNFORMATION- Irati requested Informa- tion Is not provided, the assl!nment may not be approved. See re!ulatlonsat 43 CFR Groups 3100 and .uoo. 2. This assignment COIWeys dIe following interest (continued): Land Description Percent ofInterest Percent of Additional space on page 3, if needed. Do not submit documents or agreements Û\\t1ed CaweyOO Retained Overridin~ Royalty other than this fonn; sllch docllments or agreements shall only be referenced herein. Similar nterests Reserved Previously reserved or conveyed a b c d e f , (FOI1II3OfX).3. p<Jge 3)