HomeMy WebLinkAbout939742
Form 3000-3
(January] 999)
LOC029
, ," ,.,.UNITED" STATE~ '
DEPARTMENT OF THE INTERIOR
BUIœAU~OF 'LAND<MÄNAGEMENT
. .
FORM APPROVED
OMB NO. 1004-0034
Expires:, Deceniber31,.2001
ASSIGN,MENr:OFRECORD TITLE INTEREST IN,A
LEAS'EFOROIL:,A.;ND:GAS OR GEOTHERMAL RESOURCES
Lease Serial No.
W 45371
,Lease Effective, Date
(Anniversary-Date)
06/01/51
:New SeriaLNo.
Mineral Leasing Act of 1920 (30 U;S.C. 181 etseq.)
Act for AéqWredLandB of 1947 (3D U.S.C. 351-359)
" . GeothermalSteam Act of 1970 (30:U:S;C. 1001-1025)
Departmentof:the':Intezi,orA:ppröpriatioDS Act,,"FiscaLYear 1981(42' U:S.C. 6508)
1. Assignee* Bryan A. Mau
Street 7437 Dallas Drive
City, State, ZIP Code. Austin, TX 78729
Typeorprinfpl:a:inlyln Inkiand,slgn ¡nplnk.
PARTA: ASSIGNMENT
I'
:-
*Ifmore thail-oneassignee, check here Uand list the name(s)âxîdaddiess(ešr:ðnll'adâitiOnålassi~eesonthereverse:of this form or on a
separate attached sheet of paper ; ,',' " , , , ,
TIris record title aSsignment is for: (Check one)IK10iland,·Gas Lease, or DGeothermal,Lease
Interest conveyed: (Check one or both, a.rappr;priate'j 'WRecorêfTitíe, 83'bv~rtlding Royalty, paYment out of-production or other sinùlar ,
2. ThiS assi ent con'! " s ~thei;r6nbwìÌt }iñ~rèS'f!C";:,i,¡~",·,:;:,::,:,,·:,··;:,·;,,;;.:":"i,t;';.;;;:¡;~£f3:~;<i~~j~~~~;:~'i:~~~,:;;:!~",,";'
Larid:'~cti tíqÎI\ .." """ i"""' , &,!!Rërt?ènt¡;;oféllitërest~ ,~" 'i',;!i""i!RSrbè'nf,i'Ôfif,h:"," "
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. .Rcseryed.,' ..Previously
,reserved
or,convcyed
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e
Township 22 North, Range 112 West, 6th. P.M.
Section 28: NW 1/4 NW 1/4
Lincoln County, Wyoming
Containing 40 acres, more or less
.3125
.3125 None
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RECEIVED 6/13/2008 at 10:21 AM
RECEIVING # 939742
BOOK: 697 PAGE: 29
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
'FOR·a1!M!US'EfO:N.~X:--'B9;Ni9.To'M!RI:rE;;BELOW THIS LINE
,,':UNrtED:~S:tKTEStOF::AMERICA,
This assignment is approved solely. for administrative purpoSes. Approval' does not warrant that either party to this assignment holds legal or
equitable titIetothis lease.
D Assignment. approved for above described 'lands; D Assignmeritapproved for attached land description
Assignment approved effective
D Assignmentapptoved for land description indicated on reverse
of t!ûs form.
By
(Authorized Officer)
(Title)
(Date)
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Tear PARTC: GENERAL INSTRUCTIONS Tear
1. Assignorl Assignee(s), must ,CQIIlplcte.Parts.A1. and A2,andPart.B. All,þarticsto 5.. If any,;paymentioutofproductionor simiIar interests, arrangements or payments
assigmnent must iŠign.asfollO\Vs~The,assignor(s)mus~n¡an~y.~~ign¡~.or;igina1'have..previOUSlY'íbeentcreatedi!OUhof,thednterest:,being,'assigned, 'or"uany :s~ch
copies and the assìgnee(3) must manually sign 'at least :LÓfthe3'OrigmalcoPies.pa.yments¡orinleIesture~~'UIJde¡¡:tIiis"~trincludc,a1sta1èment'g¡vmg
File three (3)completcdcopies.,of this.Jorm,in thepr.oper"BLM,off¡.,;efor; each fulldet.Ìrl1sas toamount"metiiOd ofpaymcnt, and other pertinent tcrmsas providèd
assignment ofrccordtitJe. For a transfer of:ovenidiJÌg:royâlty ihterest, :payment under 43,CFR.3106..3:135¡,or,i3241.
out of production ox: othei- similar ,interest or,pa)'IDC!1t,,,file,one (1) IÖanwilly signed 6. "Thc>lease accaunt,'must~be':m';good'stantling"before' tlris',liSsignmcÎlt"tan' be up-
copy of this.form. Tberequired: filing.fee (nonrcfunPa,ble)imust. accpmpany 'the. 'proved"'as,.providcd,,under.43"CFR:3106elUld'.'324L
l1S8ignmcnt.File assigmnent, within ninety '·(99) day-s after.date of.exeCution,of,. 7. Assignment, if approved,takcs'cffecton the firstday;of the month following the
assignor. ,dai.e''ÖffiÜngiÏrtii~,p~'BLM~offiCe.Ifa:'bónd is nc:ccs~r ,it.,~tþe fur-
2.Separa~ form must be used for each lease being affcctedbythisassignmcnt and ;Dishêif'prior..tó~åpp~â1"of'the',:assigmDent.' . ..", '
for, each. type of intçrcstconvcyed. ,', , , 8, ,Appx:qv~ofassigmnellt",?f;rec;:prd:~e,~ IPQ ~.' o(~'portionof,thc'i~~,1ands
3. InItcm N"o.2ofPart A, describe landsiaffccted(~43CFJk3'106,'313!i¡or ,crešte'S;~1eaæsOft&ìim.ioê(landthe~~:~?DSI:bUt~:~fJiønge
3241). Fotcolumns:b; c;·· d,and 'e, enter',the·intcrest"expressed.taaapercenta,ge thé'têìmS'ai1d.cóinlitions 'of theJeaseanriivêrsaiydàté',fóÍ"putposes ofþayttleI1t
oftotal.interestdn the·lease;,,:e.g., jhssigDor..assignsone,quarterofa, 20% in· of annual, rental. , . " ',,' ,
terest, enter 20% in cohunn,b, 5 % incolumnc; and U % incolumnd. 9: Ovcrriwrig'roYaltY; pày~t out'ofproductionor othersin1i1ár~'oftransfers
4. If àssigmncnt;Ìs,tDmore ,than'oDc,assignee,.enter, each'lISsigDcC's,name across mustbe,l:i1od.,withBLM, but will beacceptcd for record purposes only ; No offi-
' columnsd"e, andfnext to the rcspectiveintcrcstbeing,convcyed.~ list =ci.iil approval' will be given.
and addrcssesof any. additional assignce(s) onreversc of this form or au separatlf
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PAPERWORK REI l' A.C,T.sTATE~NT
1. Thisjnfornw,rlon is,being,eollected·pursuant-.to\the law.
2. This'!information'wilf b~'used,to create and, maintain a,record of "oiL and-
g~gfQtþermI\Uease,activity. '
3.;R~p.?~ertQ,;iþ.is·re.ql1est,inequiredto,:( btain'benefit.· , ,,<" , <";¡rl¡('~ ';:'
BLM'¡woW,t:like'you\tp¡;know that you do not 'have to respond tò:1I'ì:is"Qf..an'!lô't!ícp
Fede¡:aLagency sPQnsored~infonnation' col1ection: unless' it.displays~a:currently;
vali~Q*B,:,cC\!l~¡'.numb,er.,
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rfO'nCE
Th~.Rri..V;~~Y.,.Ac,J¡¡9f~~~74,~*~~,tß:gulatiPn. in.4~"C~?-.48@,~r.p,y,i4~!ª"'~~Y.9~:
fi.Irij,iS1i.t4~~<;';;~ö¡i9.W.h.!&'intÞ.~pnjn.connec::ü9.n'wl1;b.,mf~~tion,~~~~1~:(\tbis . :(~,e5).Ixµøi'o;1atiO~\\Í1:i9m\the'recordandlo(1the·rccord will be tr1i1lSferred to appropri-
oiLand::gJI~Æ~~~i~~J;.l(: 8e':'.I;ecord,tltle, ,asslgnment:.app~catlQn.." ...., , "..",.::.>a~:iR~'State*IQcjillor.for:eign.agencies,'whenorelevant to 'civil, criminal or regula-
õ',' ,-,,', ,.:. ....~.' ~.' -' -,,~. ,....... '> ....:.,~;~.':,~::'.:.~.: tO~J,;t.\v.esti~Ons,~ø. ~p asecu
AUTl'LQ~;'3,Q~~iIi!;:S~C. ,18(et,seq; 30U.S.C. .,lOO)"~m5.;'42,V..S:,S':;,6ß,Q8: ',.~~~~1i~~~;,:;~~~i,~;,!;" ' tions. ,
".:,:',,,,,:':,:>¡:..,.,~._."" ' . ,:', ,.,,;~. "..,~~,,,'. "",:MIlUN'G"ThlFORM:AæI0N....If:aJ}'requestecHnforma-
PRINçrpAr.'piiEQãE:.;-~~~lnio~Qn.is tOibe'U~;~pt.Pf%~~S.recDrtÚ:i~~,as- ' ,~'fÍtIie'1aSSignment:\lD.ay~noþbe'approved~ 'See"reguIations at
sigpmen~;forÁQil,~d~~geat4~~x:esourcesleasl:s. " ",,' ~p.s~ß1OO'!and;\3200,
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ROU11NE,'USES:,
-:>00030
(1)'The..ailiu9,iC;l\tionof the assignee's rights to the land or resources.
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,Q..J!1 (;:;¡" "rU' ¡"n:!orplJblic informiwon in support of notations,,(II8de onJand,status
'\j:,*~ , ' ,~~;¡nanagement, dispoSal, and use of public lands and "resoin-ces.
·'~,·'I·· .' ,_ ... \..~' -." ;'" . '.
',' !f¡:;deral agencies whèn concurrence is required prior to
, '~iiP11ands':or resources.
Tear
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Tear
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Part A (Continued):' ' ADDmONAL SPACE for Names and addresaes ofadâiti~naLassignees",in,Item No. I, if needed, or foc Land Description in Item No.2, if
needed.
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PARTB: CERTIFICATION AND-REQUEST FOR APPROVAL
1. The AssIgnor cerlifies.as owner ·,c a~ interest in"the above de.~lgnated,Iease that h7/sbe hereby assigns to the above as~i,gnee(s) the rights specified above.
2., þ/'ssignA:e certiCi<:s as follows: (a). Assignee' is a citizen o[the,U'nitedSutes; an assoe¡ialion oCsuch'citizcns; a municipality; or a corporation organized under th,
I~ws' oLtbe'Un ited Sta,tes.orof any'Sta te ,or, territory thereof. for the,.a.ssignmen t oCNPR-A leases."asslgnee is a citizen, national, or 'resident alien oftheUnit<:(
S~atesor.nsoci"tion..Q[':;ucltcitizen:;, natio-nals"rcsident alí.ens;,o,r private"public or':mun,icipal corporations, (b) Assignee is not,co,nsidered a minor,nnder the
laws:of\he.StateinwhJch,the:]ands:c~vered b~, this,aS!',i&~.m:~!1:I)fre located; (e) Assignee's chargeable interests, ,direct and indirect,.iq, each public domainao(
a~qu¡¡'ed,landSseparateIY .in'the's:ame:'Stàte:t,do'·nol,.excee~';Z'lõ':(),ß.O:acres in: o,il a ndgas leases..«)f whic,h u p'to 200~000 ac,res may bei n oil and gas 'optio ns), 0
3PO,OO'Qi'acre,s';,in 'feasesjn eaclr lea:;,ing'Distdct,in~Alâs"~:.pE;;wli:ich"ù.p't020'O;'OOO' acres (nay' be in,'options, if'this is an oil anil gas le:lse' issued"in'accordanc,
wÏ!h th~:'MïlÌ.eran..easiilg Act.Ðf,1920",or'Sil;20:0:'a,~reS;¡n any"o,ne St'a:te i(ibis is a g,ëother.mal J~a'Se;'(d)'AlI, parties holding an interest in"tbe assignmen't u>
01herw'!11',~?inc0ITI:P:Ua'OcC',wjtb·the,reguIHions{43:'eF-R"Gro'u'p'3100"or 3200) 'and"the authorizing Acts; "(e) Assignee kin complian'ce with reclamatiol
'rt;:qu¡re-~~~,tS:for.,a,!.I:~I:,ê'¡¡~ra¡:oil·an¡i:,gas, leas.e"holdlngs, as,re.q,uired by sec.' 1.7.(g) of.1he.Min<:rai' Leasing Act;, and (!) Assignee is not in violation of sec. 41 of tb,
;,"~~:~~eral~Lc' ji&~{i~~¡;~;Çj:'·'7;(/;~:~~;,"~;.,:~I~~,~~;~!;::¡;;:~i~~;~,í;;:;,;t~{0i,~;i:]>"f~:¿~¡;··::··.·!;;;:;;èi';~~~{:~:"''::~Ž:~,;:,;:':, - , . .' .
3'~~{.j:..tp~.rhls:"assl'g'nm<:nt,;constl.t)l,tecs' acc,ep.t!l'nc,e4'Ó,f;::al!::.R,p,p~lcabkte'nns,.coniiltlOnS, StlpulallOns and restrictions. perta! ning to the lease describe
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For geo¡herma!.'a~i~,:nments, an ove¡;riding,royalty max tlot be less than' on e-fo'u rth (1/4) oCone percent,of the value of output; nor grea,ter than 50 percent of the rate (
royaIlY'~ue:to the,:Un'fted :States'when'lhis assign mentis added,to all:'previously ,created'overriding roy.a:!lies,{43 CFR 3241).
'.': ,,' .~. 0.. .. ,
I certifj,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.
Exec~te.:~thið't ç day of ~ ""'- ,EC 2 0 Q..þ Execllted this '5 day of ., '^-\.JI-.
,~200~
N 'f À__' h I Frank A. Mau
ameQ,nMlgnor,as s own on ,current, ease '
," .' ,!', .....-d- ~, "ð}. )'\\}I~.:..o/?Or.'Prin~ '"
Asslgnor ~ -.. ' ,
'Frank A. Ma u (Signature)
Attorney-in"fact
",""n." q ~
, Bryan A.fMau
or .
,Attomey~in,fact
f<s-IV-
or
(Signature)
2ß165
(Signature)
preakness Drive
(Assignor's Address) ,_
Oaks Rarich-,.T:X; 78015
(City) ,(S,tatè) "
(Signature)
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Public r~porting bu:de':l for this form i~estimat~d to avernge 30 minutes per response including the time for r~viewin 'instructio . .. .
completing and reYlewtng" th,e fonn. Dl1'ect comments regarding the ,burden estimate or ,any other. as ect of this form ~'U S De ns, gathenng and m!llntammg data, an,
Manag~rnent(10().4,.0034)..Bureau Clearance Officer, (WO-63'Q).r:tv!.aWStop,AûLLS, 1849~c:.Strèër;il'N7æ..,.Wasi\.ington, D.C. 20240. partment of the Intenor; Bureau of Lan,
Title J8'OJ.:S,C.Sec,·, lOO~ makes ita,crime'for any person knowingly and willfuHy (o,rnake'to'anJ:rDepartment or agency of the United States any false fictitio ftauduJ
statements or representattona as to. any matter within its jurisdiction. ,,' , us or cr
NOTARY ACKNOWLEDGMENT
LOC031
The State of Wyoming )
: ss.
County of Sweetwater )
Frank A. Mau, as Assignor, and Bryan A. Mau, ~as:;Assignee, who proved to
me on the basis of satisfactory evidence to be the persons whose names are
subscribed to the attached instrument and further who acknowledged to me that
they executed the same on June 3, 2008.
Witness my hand and official seal.
My commission expires: August 1,2009
~"-'w""'-"'"~"""""",,,,,,~
THEDA A PORTER .................""...-_
, - NOTARY PUBLIC
COUNTY OF
SWEETWATER STATE OF
WYOMING
MY COMM'$SION EXPIRES AUGUST 1
--...__ .2009
~"'iIW~
~~j O.~
Th A. Porter, Notary Public