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Home My WebLink About936394 Form 3000-3 (January 1996) UNITED S'lru~~ AUG 2 DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT !oo~ FORM APPROVED OMB NO. 1004-0034 Expires: September 30, 1998 ,i ·1 t. \i 'I·\i' . .,." ; ,-';' If\ L'\ ,,~ .. ~_' i (-';t"l-¡'¡ ~.j; _ \ _I_~~~ tl ~.ç'r\1~r··-· ~ ;,Ùi,{~¡\;i ;,)\: LM\J \'\i\\,\hJ,J ..' ASSIGNMENT OF RECORD TITLE INTEREST IN A , ...,.. \.,. 'I?\) Mi 9: o.1ÈASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES í\;\) n~ ì 1- I..\.v , :,' D Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) "i.,_"'_ \,\":;'-" ~.\G Act for Acquired Lands of 1947 (30 U.S.C. 351-359) . ': ~~ 'I Fìn~ t., \1 \ 0\'\ I Geothermal Steam Act of1970 (30 U.S.c. 1001-1025) C I' i.. \ ." Department ofthe Interior Appropriations Act, Fiscal Year 1981 (42 U.S.c. 6508) Lease Serial No. See Attached Exhibit Lease Effective Date (Anniversary Date) See Attached Exhibit New Serial No. I. Assignee* Street City, State, ZIP Code T e or print plainl in ink and si n in ink. PART A: ASSIGNMENT Ansbro Petroleum Company, LLC 555 17th Street, Suite 2505 Denver, Colorado 80202 000387 *Ifmore than one assignee check here 0 and list the name(s) and addressees) of all additiona1 assignees on the reverse of this form or on a separate attached sheet of piper. This record title assignment is for: (Check one) II] Oil and Gas Lease, or Interest conveyed: (Check one or both, as appropriate) 0 Record Title, o Geothermal Lease D Overriding Royalty, payment out of production or other similar interests or payments 2, TIns assIgnment conveys t e fol owmg mterest: Land Description Percent of Interest Percent of Additional space on reverse, ifneeded. Do not submit documents or agreements other than Owned Conveyed Retained Overriding Royalty this form; such documents or agreements shall only be referenced herein. or Similar Interests Reserved Previously reserved or conveyed a b c d e f See Attached Exhibit 100.00 100.00 0 Those of Those of Record Record RECEIVED 1/22/2008 at 2:37 PM RECEIVING # 936394 BOOK: 684 PAGE: 387 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY h 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. D Assignment approved for above described lands; c::f Assignment approved for attached land description Assignment approved effective JUN 0 12005 o Assignment approved for land description indicated on reverse of this form. By ....' ...., 10[ Ca'''....'1f:'>'¡î· r: Lovett v ~. ¡ ¡ ¡;.J ..... LAND LAW ~XAMINER AUG 1 2 2009 (Title) (Date) fOR ASSIGNEE , (Authorized Officer) needed. STATE OF COLORADO ) ) 55. CITY AND COUNTY OF DENVER) 000388 The forgoing instrument was acknowledged before me on this 151 day of March, 2005 by Pamela S. Kalstrom, Assistant Vice President of The Anschutz Corporation, and on behalf of said corporation, Witness my hand and official seal. My Comm~s\~~~Ir:\,~¥¡p'!:~s: February 22, 2006 >" ~ ~~ ,:',' " :'<' "'._,~~:.. ".'~,..... h . .'<~ì.. ..: : ..~.' ,.." "f. '", . ,., ", f1-,' .. ,. .4ødJa~ Daria D. Desautels, Notary Public .-.~ ':.) '.._" ..J I . .,...... \ \.~ "',' .~-- '" \ ~ ~ ~..... / ~ (.' .... 1'::'1: \'?~'~~,~ . ~.. "..... ~' '\ :' .' .' , 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 States or any State or territory thereof. For the assignment of NPR-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 of the 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 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 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 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). 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 March day of March ,20 05 1 s,t ,20 05 1 st day of Executed this Ansbro Petroleum Company, LLC Assignee ¿ /~~W; ~ ~ -""""£.{~:nature) Elizabeth A. Brown, President or Attorney-in-fact (Signature) NO ATTEST REQUIRED (Assignor's Address) (City) (State) (Zip Code) Public reporting burden for this fOml is estimated to average 30 minutes per response including the time for reviewing instructions. gathering and maintaining data, and completing and reviewing the foml. Direct conmlents regarding 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 - I (0), Denver Federal Center, Building 40, P.O. Box 25047, Denver, CO 80225·0047 and the Office of Management and Budget, Paperwork Reduction Project (1004·0034), Washington, D.C. 20503. 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