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Home My WebLink About939552 \-,"'VV"J;OO orm 3000-3 lanuary 1996) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT FORM APPROVED . OMS NO, 1004-0034 Expires: September 30, 1998 ASSIGNMENT OF RECORD nTLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES Lease Serial No. WYW-175766 Lease Effective Date (Anniversary Date) FEBRUARY 1, 2008 New Serial No. ol3o 1/1,-000 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) Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT Assignee- Street City, State, ZIP Code EOG Resources, Inc. P.O. Box 4362 Houston, TX 77210-4362 If more than one assignee, check here 0 and list the name{s) and address{es) of all additional assignees on the reverse of this form or on a separate lttached sheet of paper. rhis record title assignment is for: (Check One) [8 Oil and Gas Lease, or o Geothermal Lease nterest conveyed: (Check one or both, as appropriate) [8 Record Title, o Overriding Royalty, payment out of production or other similar interests or payments 1. This assignment convevs the followina interest: Land Description Percent of Interest Percent of )'dditional space on reverse, if needed, Do not submit documents or agreements Owned Conveyed Retained Overriding Royalty ,ther than this form; such documents or agreements shall only be referenced or Similar Interests lerein, Reserved Previously reserved or conveyed a b c d e f rownship 20 North, Ranae 113 West. eU1 P.M, 100,00% 100.00% None None None 3ection 2: NE1/4SE1/4 :ontaining 40,00 acres, more or less ~r County, Wyoming Jincoln zO RECEIVED 6/5/2008 at 2:28 PM "' RECEIVING # 939552 BOOK: 696 PAGE: 488 I. JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 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. o Assignment approved for attached land description o Assignment approved for land description indicated on reverse of this form, o Assignment approved for above described lands; Assignment approved effective By (Authorized Officer) (Title) (Date) 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 ) ) 55. ) L'OV4cS9 COUNTY OF LARAMIE The foregoing instrument was acknowledged before me the 14th day of January, 2008, by C. Steven Stacy, as President of Hoover & Stacy, Inc. . WITNESS my hand and Offi~~ My Commission Expires: ¡( ~ ~ 7, :10 I Robin K. Sanders, Notary Public ROBIN K: SANDER.!... - NOTARY PUBLIC COUNTY OF _ STATE QF LARAMIE _ WYOMING MY COMMISSION. EXPIRES JUN. 7, 2011 PART B: CERTIFICATION AND REQUEST FOR APPROVAL 1, 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 of 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 interest, direct or indirect, in each public domain and acquired lands separately in the same State, do not exceed 246,080 acres in 011 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 wilh 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, slipulations 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. ~ do, of h¡tùf EOG Resources, Inc. 14th day of January ,20 08 Executed this ,20 f)g Executed this Name of Assignor as sho Assignor ~ or Attorney-in-fact Hoover & Stacy, Inc, Please type or print Cheyenne (City) (Assignor's Address) WY (State) ::~:"-u~ ~~ " ames. etc er Agent & Attorney-in-Fact C, teven Stacy, President No Attest Required PO Box 2328 82003 (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 regarding the burden estimate or any other aspect of this form to U,S, Department of the Interior, Sureau of Land Management, Bureau Clearance Officer, (DW-110), 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 Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make 10 any Department or agency of the United States any false, fictilious, or fraudulent statements or representations as to any matter within its jurisdiction, ·U.S, GPO: 1992-774-017/67022