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Home My WebLink About874100 - - - FornI30DQ-] (October 1992) oo"j"; J--- UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT w~ '-L.~(ll FORM APPROVED OMB NO. 1004-0034 Expires: July 31,1995 ,.. , '\_~,',.;:\j ~ \....~:.~.~ ..~j\.rl Ur- . S.J ~:L~~~~' 2 ~ J ' ~ I:" : i~' 0 .\,-~ -' r ..J ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES Lease Serial No. W-113647 ... . __ . 'J - - Mineral Leasing Act of 1920 (30 V.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.c. 351.359) Geothermal Steam Act of 1970 (30 V.S.C. 1001-1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 V.S.C. 6508) Lease Effective Date (Anniversary Date) 12/1/88 New Serial No. Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT 1. Assignee* Street City, State, ZIP Code Celsius Energy Company 1331 17th Street, Suite 800 Denver, Colorado 80202 BOOK ':1~~!?PRPAGE 198 RE;..CEIVED * If more than one assignee, check here 0 and list the name(s) and addressees) of all additional assignees on the rev~f'i,,9f() l~Yf l!(3lJ~~ f'Y aC LI separate attached sheet of paper. ~ r~ li This record title assignment is for: (Check one) t8J Oil and Gas Lease, or 0 Geothe~ i4 I 0 0 Interest conveyed: (Check one or bOlh, as approprlale) C8J Record Title, 0 Overriding Royalty, interest or payments O I 1"~1 ''J-C r'..- 9' I ... ,.r J'.~ ,.. \) t d ~ _ t 2. This assignment conveys the following interest: Land Description Additional space on reverse, if needed. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein" payment out of produqt}olJ., RJ!" \llher. 6if1lil,ar" I r.... Li t:~ H 1\ I \j 1:::. 'I',' I"', 'u: '. c - " C ::'> 'IH\I I ~\ Percent of Interest Owned Conveyed Retained c Percent of Overriding Royalty or Similar Interests Reserved Previously reserved or conveyed f e a b d Township 18 North. Range 113 West Section 2: Lots 1-4, S/2N/2, 8/28/2 less 25.25 acre UPRR ROW 12.5% 12.5% -0- -0- of record containing 453.95 acres, more or less Uinta County, Wyoming CERTIFI b be n tr 8 and COrTIp. ralive coPy of the ffieial reCOT 15 on tile; J N 1~ 01 . 7l.~tC '. -L L./ URE~O lIAN M NAGEMENT o IGIN L 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 ~table title to this lease. JZI Assignment approved for above described lands; 0 Assignment approved for attached land description Assignment approveleffective JUN tl1 1997 " ~ ~'1f:,/ ,,' . / By ,=,;:;7'/ L-[/t-c~;11 -" ..([-I.-(.'./v.1.---' (Authorized Officer). o Assignment approved for land description indicated of this form. on reverse LAND LAW EXAMINER (Title) AUG 1 1 -qT1 (Date) ~m. .... ~ Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in hem No. I, if needed, or for Land Description In hem No.2, if needed. CERTIFIED to be n true and comparative, copy of the official records on file " . JUN 19~/~~" BU~rro;;NA~EMENT o t-J 't'Ll.10 0 199 PART B: CERTIFICATION AND REQUEST FOR APPROVAL I. The Assignor certifies as owner of 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 Slates or of any State or territory thereof. For the assignment of NPR-A leases, llssignee 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 II minor under the laws of the State in which the lands covered by the assignment are located; (c) Assignec's chargeable interest, 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 requiremenlS for all Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral Leasing Act; and (I) Assignee is not in violation of sec. 4] of the Mineral Leasing Act 3, Assignee's signature to this assignment constitutes acceptance to all applicable terms. conditions, stipulations and restrictions pertaining to the lease described herein. 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). J certifY that the statements made herein by me are true, complete, and correct to the best of my knowledge and helief and are made in good faith. Executed this 22nd day of April ,1997 - Executed this 22nd day of April 19 97 '- Name of Assignor as shown on current lease Amoco Production Company Please type or print CELSIUS ENERGY COMPANY Assignee BY :~2;:~ (,-( '\ G ...-t. NoIidloh(Signalure) , or ~ President & CEO Anomey.in.fact Assignor (Signalllre) or /I?, J ~ [v/ ~v Attorney-in-fact (Signaturc) (><cr,,; (Signalure) P. O. Box 800 (Assignor's Address) Denver, Colorado 80201-0800 (City) (Slale) (Zip Code) Public reponing burden for this foon is estimated to average 30 minules per response, including the lime for reviewing instructions, gathering and maintaining data, and completing and reviewing the fonn. Direct comments regarding Ihe burden estimate or any othcr aspect of this fonn to U.S. Department of the Inlerior, Bureau orLand Management. (Alternate) Bureau Clearance Officcr, (WO-HI), 1849 C Streel, N.W., Washington. D.C. 20240, and Ihe Office of Managemenl and Budget, Paperwork Reduction Project (1004'0034), Washington, D.C. 20503. Title 18 U.S.c. Sec. 1001 makos it a crimc [or an)' person knowingly and willfully to make 10 any Depanmenl or agency of the United Slales any false, fictitious or fraudulent slatemenls or retlresenlalions as 10 any matter wilhin its jurisdiction. .U.S. GPO: 1992 -774-017/67022 - - -