HomeMy WebLinkAbout874102
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S0521S
Form 3000-3
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UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
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FORM APPROVED
OMB NO. 1004-0034
Expires: July 31, 1992
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ASSIGNMENT OF RECORD TITLE INTEREST IN A I Lease Serial No.
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES I W 113647
i Lease Effective Date
Mineral Leasing Act of 1920 (30 U.S,c. 181 et seq.) I (Anniversary Date)
Act for Acquired Lands of 1947 00 U.S.c. 351-359) " ,,' I December 1) 1988
Geothermal Steam Act of 1970 (30 V.S.C. 1001-1025) , INS 'al N
Department of the Interior Appropriations Act. Fiscal Year 1981 (42 U.S.C_ 6508) ew en o.
Type or print plainly In Ink and sign In Ink.
PART A: ASSIGNMENT
1. Assignee'" Celsius Energy Company
Street 1331 17th Street) Suite #800
City. SUIte. ZIP Code Demter. CO 80210
"'If more than one assignee. check here 0 and list the name(s) and addressees) of all additional assignees on the reverse of this form or on a
separate attached sheet of paper_
This record title assignment is for: (Check one) [Xl Oil and Gas Lease. or 0 Geothermal Lease
Interest conveyed: (Check one or boch. as appropriace) ru Record Title. 0 Overriding Royalty. payment out of production or other similar
imerests or payments
2. This assignmem conveys the followine: interest:
Land Descri tion
Additional splice on reverse. if nccdcd. Do nOI submil documents or agreements other than
this fonn; such documcnlS or agreements shall only be referenced herein.
Percent of Interest
Owned Conveyed Retained
Percent of
Overriding Royalty
or Similar Interests
a
b
c d
Reserved Previously
reserved
or conveyed
e f
0 12.5
Township 18 North~Rqnge 113 West, 6th P.M.
Section 2: Lots 1-4, S/2~/2, S/2S/2
(Less 25.25 acres, more or less in
UPRR R/W 10-21-1868)
Containing 453.95 acres. more or less
Uinta County, Wyoming
25
25 0
CE!FIED
to e n trUt1 an comparallv copy
of ttle officia records on ile
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BOOK_,~=~~?n~:PR PAGE___:.~." .
REeEI' ED
JNCOLN COUl'TY CLE l<
JUN
874102
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I<EMMErlER. I'lYOMING
FOR BLM USE ~~~~~A:To:":~:~LOW THIS LINE .QR{GLil~
This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assigmnent b.olc~ legal or
equitable title to this lease.
'[j Assignment approved for above descrihM lands:
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Assignment approved effective
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o Assignmem approved for attached land description
[J Assignment approved for land description indicated on reverse
of this fonn.
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Part A (Continued); ADDITIONAL SPACE for Names and addresses of additional assignees in Item N~..L if n~ed. or for Land Description in Item No.2. if
needed,
U874102
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CERT!FIED
to be n true' and comparative. copy
of the official records on fila
JUN 1 YZ001 _. . .
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BUREAtl-UflLAND MANAGEMEN I
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
\, The Assignor ('erlifies as owncr of an inlnest in Ihe anolle designal('d lease Ihal he/she hereny assigns 10 Ihe aholle assignee(s) Ihe righls specified'abolle,
2, Assignce cenifics as follows; (a) As.\ignte is a citizen of Ihe UnilCd SlaleS; an associalion of such ciliuns; a municipalily; or. corponlion organi"ed uader the
la""s of Ihe Uniled Slales or of any Slale or lerrilory Ihereor. For Ihe assignmenl of NPR-A le.ses. assignee is a cilizen. nalional. or residenl alien of the Uniled
Stales or aSSOcialion of such citizens. nalionals. residenlaliens or prillale. puhlic or municipal corponlions. (b) Assignee is nOI considered a minor under Ibe
laws of the Slale in which Ihe lands cOllercd by Ihis assignment are localed; (C) Assignee's chargeable inltreSls. direct and indirecl. in each public domain aDd
aC'luire.! lands separalely in Ihe same SI.le_ do nOI ellC'ccd 246.080 acres in oil and gas leases (of which up 10 200.000 acres may be in oil aDd gas options). or
300,000 acres in leases in each leasing District in Alaslta of which up 10 200.000 acres may be in oplions. ir Ihis is an, oil ant,! gas Itne issued in accordance
wilh Ihe Mincnl Leasing ACt of 1920, or 51.200 acres in anyone Slale ir Ihis is a geothermal lease; (d) All panics holding an inler~S1 in Ihe ..signmenl He
olherwise in compliance wilh Ihe regulalions (43 CFR Group 3100 or 3200) and Ihe a1llhorizing ACls: ,e) Assignee is in compliance wilh recl.m'lion
requircmcnls for all Fedenl oil and gas leasc holdings as required hy sec. 17(g) or the Mineral Leasing ACI; and (I) Assignee is nOI in lIiolalion cC sec. 41 or Ihe
Mineral Leasing Act.
]., Assignee's signalure to this ass'gnment ConstilUles a('('eplanee of all applicahle terms. condilions. slipulaliuns and rcslrielions pUlaining 10 Ihe lease described
herein,
For geolhermal assignmenls..n ollerriding royallv mav nOI be less than one.founh (I/~) of One percenl of Iht 1I.lue of output. nor greller lhan 50 percenl of Ibe rale ('1
royallY due 10 the Uniled Slales when Ihls assignmenl is added 10 all prelliously cruled ollerriding royallics (J:\ efR )2~ I),
1 certify that the statements made herein by me are tnle. complete. and correct 10 the beSt of my knowledge and belief and are made In good faith"
E~ccuted this
5th
day of
April
.1995
E~ecuted this
13th
,19 95
Company
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Assignor
or Bruce E.
Assignee
"ftG....] in-illCt-
Leon
1777
;,f'resident or
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R. Bailey (SignalUre!Assistant Secretary
South Harrison St., P-1
(Assignor's Address)
J
Denver
(City)
CO
fState)
80210
(Zip Code)
Puolic reporling burden for Ihis form is eSlimlled 10 oller.ge 30 minUles per response, includin~ li'e lime for relliewing inslruclions, gllhering .lId mlia..inin!! d.I..
and cnmpleling IOd reviewing the form, pircct cummenlS rC[l:arding Ihe burden eSlimale or .nv olher aspecl of this form 10 U.S. Deparlment of the Interior. Bure.u of
Land M.n.gement. (Allern..e) Bureau Clearance Officer. (WO-77 I). 1849 C Streel. N,W.. W.shinglOn. D,C. 202~0. ud the Office of Mn'geDlenl..d Budgel.
P'l"'rworl< Reduclion Project (1004-0034). W.shinglon. D.C. 20503,
Tille 15 V.S.C. Sec, 1001 makes II a cnme for any person Knowmgly anu willfully 10 make 10 any Depanment,or agency of the United StaleS any false. ftcliuous or fraudulent
stateOlCnts or rc.:l'resentar '''/IS as 10 any maner within Its ,lurisdicllon,
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'U.s. _..._. PmIInO ~ lilli' - 573-0IllI2Il1062
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