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Home My WebLink About937909 Form 300().3 (May 2(06) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES FORM APPROVED OMB NO. 1004-0034 Expires: April 30, 2009 Lease Serial No. W-024793 Lease Effettive Date (Anniversary Date) February 1, 1954 New Serial No. 000721. Mineral Leasing Act of 1920 (30 V.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C 351 - 359) Geothennal Steam Act of 1970 (30 V.S.C. 1001-1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 V.S.C. 6508) Type or print plainly In Ink and sign in ink. PART A: ASSIGNMENT la. Assignor L ~ (60%) ROEC, Inc. (40%) Colorado State Bank and Trust, N.A. Richard L. Peterson Trust S1n:et 528 S. Corona Street Custodian FBO Thomas Cassell SD Rollover IRA dated 10-25-1990 City, Stale, ZipCode Denver, CO 80209 1600 Broadway P.O. Box 8 Denver, CO 80202 Attn: Trust Department Douglas, WY 82633 ·Ifmon: tbao one assignee, check here Q9 aød list the name(s) and address(es) of aIIaddtional assignees on page 2 of this fODD or on a I1epIIIIe atIached sheet of pøper. Thisra:ordtitleassigmneutisfur: (Checkone) [X] OilaodGuLease, or DGeoIbemIaiLease InIerest oonveyaI: (Check one or both. os approprioIe) D RœonI Tide, ]] Oveniding Royalty, payment out of produçtion or other sånilar in1m:sIs orpaymems 2. This assignment CIJIlYeyB the IòIIowing interest: 2¿ Land Descl'Í¡)tion Percent oflntereat Percent of Additiooal space on page 2, if needed. Do not submit d()ÇUßIeots or agreements Owned Conveyed Retained Ov:eqidin£ Royalty other than this form; such document! or agreements shall only be referenced herein.. Smular terests Reserved PrevioœJy reserved or c:oøveyed a b c d e f Township 26 North, Range 113 West, 6th P.M. Section 14 : SE!¡;NW~, SW~ 0.9375" 0.9375% 0% Section 22: E~NE~, SW~E~, SE!¡;NW~ Section 23: Lots 1,2,3,4, N~NW~ Section 26: Lots 1,2,3,4 Containing 598.70 acres more or less. This assignment of overriding royalty shall be effective February 1, 2008. FOR BLM USE ONLY . DO NOT WRITE BELOW THIS UNE UNITED STATES OF AMERICA This assipmeat is approved solely for admlllistrative purposes. Approval doa not wamat that either pal1y to tIús assipllleat holds legal or equitable title to this lease. D Assignment approved for above described lands; 0 Assignment approved for attached land description Assignment approved effective D Assignment approved for land description indicated on reverse of this fonn By Bureau of Land Management (BLM) (Continued on page 2) (Title) (Date) - RECEIVED 3/31/2008 at 10:29 AM RECEIVING # 937909 BOOK: 690 PAGE: 721 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Part A (Continued): ADDITIONAL SPACE for names aud addresses of additional assignees in Item No.1, if needed. or for Land Description IU "~III nv. 2, if needed. ACKNOWLEDGMENT 000722 STATE OF WYOMING ) ) s.s. COUNTY OF CONVERSE) The foregoing instrument was acknowledged before me by Richard L. Pèterson, Trustee of the Richard L. Peterson Trust, dated 10-25-1990, on this 24th day of March, 2008. Witness my hand and offical seal. DIANA K. EMERY - NOTARY PUBLIC County of Conveïse My Commission Expires: State of Wyoming, June 19, 2011 £lMUi K ~ Diana K. Emery - N~ary Public PART B· CERTIFICATION AND REQUEST FOR APPROVAL 1. The Assignor certifies as owner if 10 intc:rest in the above designated lease that he/she berc:bý assigns to the above assiguee(s) the rights specified above. 2. Assign" certifies as follows: (a) Assignee is a citizen of the United States; an associaIion of such citizens; a'mànicipality; or a corporation orpnizcd. under the laws of the United States or of any SIatI: or territory thereof. Fnr the assigmuent ofNPR-A leases, assignee is a citizen, naticma1. or resident alien of the Uaited States or association of sucb citizens, nationals, resident aliens or private, public or municipal corporations, (b) Assignee is not considc:red a minor under the laws ofthe State in which the llOds covered by this assigmuent sre loçatc:d; (c) Assignee's chargesble interests, dirc:c:t aad indirc:ct, in each public domain and acquired IBDds separately in the same State, do not exceed 246,080 ams in oil and gas leasa (of which up to 200,000 amsmay be: in oil and gas options), or 300,000 acres in leases ÌD each leasing District in Alaska of wbich up to 200,000 ams may be in options, if this is an oil and gas lease issued it aceordance with tbe Mineral Leasing Açt of 1920, or S 1,200 acres in any one State if this is a gcodu:rmallc:ase; (d) All parties bolding an interest in the assignment are otberwise ÌD compliance with the regulations (43 CFR Group 3100 or 3200) and the: authorizing Acts: (e) Assignee is ia compliance with reclamation rc:quirc:meøcs for all Fc:deraJ oil and gasleasc holdings as required bysa:.. 17(g) of the MineraJ Leasing Act; and (f) Assignee is not in violation of sec. 41 of the MineraJ Leasing Act. 3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described henin. For geotbc:rmaJ assignments, ID ovemding royalty may not be: less thlD one-fourth (1/4) of one percent of the value of output, nor greater than SO pc:n:ent of the rate: of royalty due to the United States wben this assignment is added to all pn:viously created ovemding royalties (43 CFR 3241). I certify that tbe statements made herein by me are true, complete:, and correct to the best of my knowledge IOd belief and are made in good faith. Executed this 24th day of March 20 08 Executed this day of 20_ Name of Assignor as shown on CWTc:nt lease Richard L. Peterson Trust, dated 10-25-1990 (Please: type or print) SEE ATI'ACHMENTS ~~.c~~ All or . ~ By: Richard L. Peterson, Trustee omC:Y-Jß-lact (Signston:) Assignee or Attorney-in-fact (Signatore) Assignor P.O. Box 8 (Signaton: ) Douglas (City) (Assignor's Addn:ss) WY (State) 82633 (Zip Code) Title 18 U.S.C. Sc:c.IOOl makes ita aime for any pmon kaowiogJy and willfully to make to any Department or agency oftbe United Statc:s any fabie, fictitions, or fuludulent staœmenls or rc:prc:scnIatÏOIIs as to any mailer within its jurisdiction. (Continued on page 3) (Fonn 3000-3, page 2) 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 COLORADO ss. 000723 COUNTY OF DENVER This instrument was acknowledged before me on the Z7ti.. day of March, 2008, by William E. Richardson as President of ROEC, Inc., a Colorado corporation, on behalf of said corporation. .w4ET8ORIANÞ Notary PuÞØc -_of ~. Db·Og·tO Given under my hand and seal of office this of March, 2008. TIONANDREQUESTFORAPPROVAL 1. The Assignor certifies as 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; an association of such citizens; a municipality; or a corporation organized under the laws of the United States or of any State or territory thereof. For the assignment ofNPR-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 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 3 \00 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). Executed this 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. 2/ii day of 20_ Executed this day of March 20 -ºª- Name of Assignor as shown on current lease (Signature) ASSi~~:~etypeo~~I'~ (Signaturek or William E. ichardson Attorney-in-fact Presid~ture) Assignor or Attorney-in-fact (Signature) (Assignor's Address) (City) (State) (Zip Code) 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. (Continued on page 3) (Fonn 3000-3, page 2) 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 COLORADO COUNT¥, OF ~y{r ss. 000724 This instrument was acknowledged before me on the ~i~ day of March, 2008, by Susan Early as Agent of Colorado State Bank and Trust, N.A., Custodian FBO Thomas Cassell SD Rollover IRA, on behalf of said entity. JANET BORlAND Notary Public State of Colorado Given under my of March, 2008. -&1'- PART B - CERTIFICATION AND REQUEST FOR APPROVAL 1. The Assignor certifies as 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; an association of such citizens; a municipality; or a corporation organized under the laws of the United States or of any State or territory thereof. For the assignment ofNPR-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 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 requirements for all Federal oil and gas lease holdings as required by sec. 17 (g) ofthe 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 day of 20 Executed this c21~ day of March 20 ºª- Assignor or Attorney-in-fact ISîrmature) (Signature) Susan Early AgentiSignature) Name of Assignor as shown on current lease (Signature) Assignee or Attorney-in-fact (Assignor's Address) (City) (State) (Zip Code) Colorado State Bank and Trust, N.A Custodian FBO Thomas Cassell SD Rollover IRA 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 tTaudulent statements or representations as to any matter within its jurisdiction. (Continued on page 3) (Fonn 3000-3, page 2)