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(Date)
(Title)
(Authorized Officer)
By
D Assignment approved for attached land description
D Assignment approved for land description indicated on
reverse of this form.
D Assignment approved for above described lands;
Assignment approved effective
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 equitable title to this lease.
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Of Record
. .
Percent of
Overriding Royalty
or Similar Interests
Reserved I Previously
reserved
or conveyed
elf
Subject to the terms and conditions of that certain Letter Agreement dated April \ 20, t ." f+ ì
2001, by and between The Wolf Haven Corporation and Tom Brown, Inc. '<) ~ ~) U ¡
To~nshiD 23 North. Ranoe 114 West. 6th P.M.
Sel Ion 07: Lots 1(47.15), 2(47.16), 3(47.18), 4(47.19), E112, E112W112
Section 08: All
Section 09: All
Containing 1 ,948.68 acres, more or less
Lincoln County, Wyoming
*. It is the intent of this assignment that The Wolf Haven Corporation will deliver
unto Tom Brown, Inc. an 82.50% net revenue interest in this lease, retaining a1
overriding royalty interest equal to the difference between 17.50% and all presently
existing and outsta(1dinglea$6 burdens which shall include lessor's royalty and all
overriding royalties or similar interests burdening the leasehold.
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GE V'J
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BooKL51~JipR
None
100.00% I All
b I c I d
a
Percent of Interest
Owned I Conveyed I Retained
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o Overriding Royalty, payment out of production or other similar interests
or payments
Thi~1ecord title assignment is for: (Check One) ~ Oil and Gas Lease, or
. . , .
Interest conveyed: (Check one or both, as appropriate) 'IZI Record Title,
o Geothermal Lease
o and list the name(s) and address(es) of all additional assignees on the reverse of this form or on a separate
*If more than one assignee, check here
attached sheet of paper.
Lease Serial No.
WYW-143677
Lease Effective Date
(Anniversary Date)
December 1, 1997
New Serial No.
FORM APPROVED
OMB NO. 1004-0034
Expires: September 30, 1998
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Tom Brown, Inc.
555-17th 'Street, Suite 1850
Denver, CO 80202-3918
Assignee*
Street
City, State, ZIP Code
1.
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351-359)
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
ASSIGNMENT OF RECORD TITLE INTEREST IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
Form 3000-3
(January 1996)
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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.
STATE OF WYOMING
COUNTY OF LARAMIE
)
) SS.
}
On this 23rd day of April, A.D. 2001, before me personally appeared MARC RANDAL STRAHN, President of The Wolf Haven
Corporation, to me personally known, who, being by me duly sworn, did say that he is the President of The Wolf Haven Corporation and
that the seal affixed to said instrument is the corporate seal of said corporation and that said instrument was signed and sealed on behalf
of said corporation by authority of its Board of Directors, and said President acknowledged said instrument to be the free act and deed of
said corporation.
Witness my hand and seal this 23rd day of April, A.D. 2001.
ÑÕia~' tf -OfÞ15
Address: Cheyenne, Wyoming
My Commission
"u fARV PUBLIC.
I
ACKNOWLEDGMENT
STATE OF COLORADO)
)ss.
COUNTY OF DENVER )
On this .1.:L~ day of May 2001, !\\~orttllfftrtllMail A. Bates, a notary public for the State of Colorado,
personally appeared Rodney G. ~ftIAIs*'I. wledged himself to be the Vice President - Land of
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Tom Brown, Inc., and that he~&s ~ti ice ~~t, being authorized so to do, executed the foregoing
instrument for the purposes t~"feÍ1l~<fÃtßif94R ¡o':; \
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MyCotn11Ússion Expires \. ~·o. U B L \ C,/N?ry Pu c: Gail Anne Bates
May 14. 2001 ~ -</Ä.... .0·" ~siding at 8335 Fairmount Dr.,
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""'''' o¡: COL()\\~~1\\~venYer, Colorado
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rate UIIUYi::UlY UUC: I.U LlIC VIIILCU VLCU.g~ .WII"-" &111.-:) D~~IYIIlII'UoII"I'" "",WlA&'tUUn 1"""..."......"'3 v...................... "".-"'-"'ø .-J-.....-- \._ _. .... __. " '
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I certify that the st~TÊJ~,t:.~~e herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Executedthis<:;: <~3rd"';¡!~~~:',:~íi(of A ril ,20 01 Executed this T'+-"- day of May ,20
N.me of ~~I¡-';'~ .... tlon Tom Brown, Ino. , '" / <~i'
ASSignQ~~: ttÃ.\. ;; Assignee ~~~~... ~,,~,t1f~:...
Attor~~y-i~-;~~" ,?N~ Âtte~'~~~ire~reSident ~;~~ Vice pre=~~~~tG~~t~~~~ <;.,.Ií,)7
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P.O. Box 2480,; /. ;",': :.¡,."
~. .. ... ,. . (Assignor's Address)
ATTEST:
a::t-R r·v· , . ..' .
...ì. l't
Cheyenne, WY 82003
(City)
(State)
(Zip Code)
Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regardihg the burden estimate or any other aspect of this form to U.S, Department of the Interior, Bureau of Land
Management, Bureau Clearance Officer, (DW-11 0), Denver Federal Center, Building 40, P. O. Box 25047, Denver, CO 80225-0047, and the Office of Management and
Budget, Paperwork Reduction Project (1 004-0034). Washington, D.C. 20503
Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency of the United States any false, fictitious,
or fraudulent statements or representations as to any matter within its jurisdiction.
·U.S. GPO: 1992-774-017/67022
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