HomeMy WebLinkAbout939743
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Form 3000-3
(January 1999)
",UNITED STATES,
DEPARTMEm:OF THEIN1'ERlOR
BUR:EA.UiOF'LAND(MANAG:EMENT
PQRMAPPROVED
OMB NO. 1004-0034
Expires:, December'3l,200l
ASSIG~,MENJ.,OF RECORD TITLE INTEREST IN,A
LEASE.FOROILAND:GAS OR GEOTHERMAL RESOURCES
Lease Serial No.
W 45370
l>OC032
Mineral Leasing. Act of 1920 (30 U.S.C. 181 etseq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351-359)
. GeothermalSteamAct of1970 (3üU.S.C. 1001-1025)
Departmentof::thè',futerj:òr-Appropriations Act,:;FisCålYear 1981 (42U:S.C. 6508)
,Lease ,Effective Date
(Annive~ Date)
06/01/51
"New Serial ,No.
Type orprlnlp1;a:lhlyJn IlIJk'~'andslgn In'lnk.
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'P~RTA:ASSIGNMENT
1. Assignee* Bryan A. Mau
S~t 7437 Dallas Drive
City, State, ZIP Code . Austin, TX 78729
"'If more :thaiJ.oneasSignee, checkhereD and Iistthe name(s)áD:daddress(èŠ):òfãlladilitionäl aSsi~eeson the re'¡~rseof this form or on a
separate attached sheetoi'paper.- , ", ,
This record title aSsignmentis for: {Check one) 0 OiIand-Gas Lease; or D Geothermal Lease
'Interest conveyed: (Check one or both, a.r appr;priâte)' '¡~Recorã'Titie,G{J-bv~rtiding Royalty, paYment out of-production or other similar ,
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2. ThiS assi ent, conve ,s ''the'!fóUò\v;ih'·\'iÌ!,~i~'t:t::',:,.~,::¡""":;~~.",,,· ":';-,' .ì;_:;:;::::;;';:'Ll!,i;~r;;):"::i:,,\"D:r\'l~::;:;-:;;;~;:i;;{:{";';~,;;1;;(:,',;,: ,>,';) ç:),¡\i\;f".,,:;;~,¡l<~,'I,+d.,.¿:;r;:';'"
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,reserved
ol"conveyed '
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Township 22 North, Range 112 West, 6th P.M.
Section 20: S 1/2 NE 1/4; SE 1/4 Nt<'! 1/4;
E 1/2 SW 1/4; SE 1/4
Section 21: SW 1/4 NW 1/4; NW 1'/4 SW 1/4
Lincoln County, Wyoming
Cont~ining 440 acres, more or less
._. 3 1 2 5
.3125 None
-7
RECEIVED 6/13/2008 at 10:22 AM
RECEIVING # 939743
BOOK: 697 PAGE: 32
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
'F0R;;BI:iM'US'E'¡ON:~Y'''';;D9.,NR.T"WRITE0BELOW THIS LINE
':UNrÌEr>1s'rA'tE.S~ØF'~CA
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'1ands; DAssignmeritapproved for attached land description
Assignment approved effectjve
D Assignment'approvedJor land description indicated on reverse
of this form.
By
(Authorized Officer)
-" - ~ ~. -
(Title)
(Date)
Tear PART C: GENERAL INSTRUCTIONS Tear
1. A.5signorl A.5signee(s). must complete,Parts.A1.and A2, and'Part B., AILparties,to 5...Jfany,;payment,outofproduction'or sími1ar inte=ts, arrangements or payments
assignment must,.šign. as .foUows:, Thc,assignor(s), must.tnan11J!JJy§sigµ;~;orjgïnaJ. JJave"previously,;¡been:,createdi¡out:of,theinterest,beingrassigned¡01'dfany '.such,
copies and the assìgnee(s) mustmanWlllysìgnat least ,Lofthe'3origmakopies.payments¡orjntctests,am1~FY~:hlIlderithis,1lSSigx:¡mem;"iDclude.a1~gi.ving
File three(3)comp1etedcopics "of this·form.in. theproper;BL}¡{^offlcdor:each full detäi1sas to'!IDJOWJt"metIlOdOfpayment, andotherpcrtinent tecmsas providéd
assignment of recordtitJe. For a transfer ofoverridìng.royalty ihteiest, .payment under 43 rCI1RJ 106,o3135¡lor.,3241.
out of production or othci- similar ,interest Qr.,paymetlt,:fi1e'ione(l),riumwilly signed 6. Thodease· !lCCOUDt1musti,be·¡.ìihgood'standingi'before,this"llssignmont"éan' be ap-
copy of this, form. TbcÌ"equìred' filingJce, (nonroiundable),must'ß9Company:the ",proved,'as-'provided"undor4S'CFR,3106o¡urd"324k
assignment. File, assignment within nincty:, (90) clay,s after,clate,· of ,cxecution, of, 7. Assìgnmcllt, if approved, takes'cffecton tho firshlay,of the month following the
assignOr·date:'df:filingiií-tliC:Pr¥f'BÐÆOffiee,.Jf a-bond isnccessary, ,it.1m.1~t,be fur-
2. Soparau: form must be used for cachlcase being affectedbythisassignmcntand:IiìshêH'prioc,tO'åpprO'¿'å1"Of'the',:assígDmCút. ' , "_"
for,eacbtype of into=t conveyed. ",,' , , "" 8. ApPIP-valof assignmcnLÇfrec0rd;:titloto H)()%o(alportion(}f.the'l~~~
3. In:ltem No. 2 of Part A, describelands'aff~(Sec43'C~':3'106<~135,or '~,;~'I~~Öfme.rë:tiûn&tand~~~,~~,;bûftJ?éS}14=(~;ffa"ge
3241)., For ,columns ·bi c;,d,and"o,' onter·,tho:mtercst'cxpreswlasa,percentage 'tb'c'teÌ'IÏÎSa:nìlconditions'of thcJeaseanmvcrsary'dáte',foq)llrPOSèS of payment
oftota! interestintho¡lcase;;c.g.,Jfassignorassignsonc,quarterof a 20% in- of anp~,,:renta1.
terest,cnter 20% in column:b, 5 % in, co1umnc, and:15 % in column ,d. 9~ 'Overridirig'r6ya1ty,pay~ntout'ofproductionor other,siI'niJlirtypoSoftransfers
4. If assigmnent, is to more than :oneassignee,ènter, cacb.assigneê'snameacrossmustbeß1od ;with BLM, but will be accepted for record purposeS only ; No offi-
columns d, ,c, and! next to the respectivc interest bcing,conveyed.Also list namescilil approval' will be I!:Ìven.
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PAPERWORKREDpt"''l'TnlI.r · C:r$TAn:~NT
1. ThisAnfonTI\I,tlon is, 'Q' _ _, ~.ted·pursuant',tothe law.
2. This'~nformation'wilf be--used,to create and, maintain' a recordof'oiLal1&
g~/geQtþ.ermaUease,activity. .
3.,R~I?~~;;to-Ïþjs're.q\!.est.ís: required to,:obtain :benefit., ..~ .,:,.:;)¡¡,~::"
BLMi:w,O:uJ~:líke'You~to.~knolw tha()you'do norhave- to respond tô.'tJiiši.br-'arir.ô'ilieì:~
Fede¡;aLagency' spq¡¡sore,d::information collection: unless' it,displays;:a::currently:
vali~Q~~,col1~()tnumi?e~. .
NOTICE" "
',-.".-¡(Ji"f"· .,."
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The:~v,acy:,Ac.,~'ºf;,1~74)anq,~e.,tegulati,9n,iIl4~·,CF¡æ2.48@,;¡µ:p'y.i4.e.i\$.at,¡>y,9u~þe..
fur:¡¡,iS1i~ì~~jif:Ö¡ì9.wh.!&'jnf~~on,in.co.nn~¿'n-,wltft;;inf~~tion:;~i~!þ)\\\this
oil:.and:,g¡¡~j,r,~7~;.I9'Ss¡¡ec<ord,tltle, .asslgnment,appli.canon"i .,,:,\,.: ,c,;;.,¡,,::.
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Au.œ.O~~'3.Q}¡:i;r:~s:C:. ,18,Ì\et;,seq; 30U:S.C..1Ø1) ~,;cil~;':42,V~S;.q:~'6~,O~;
"::.'..~:.:-·;:~:~<,~~::~.~·~:~..tf..~~.,:.-..~.~.;'. .\. ;... . ;." .,- 'i,:" .,. ·.~i~'· .,·~':~à~~,·,:~.
PRJJ)!:ÇIpALj)iJ~ö.§%~t;i:infor¡:n,atiqn:,isto;be,u$~t,()"prq<::~~s,record:,ti*,IlS-
signme1J,~~for,..o.il~!µl,ct;igaSfgoo.tl¡er,rqål~~ourcesjeases. . '"
,K~~,USES: . l:OC033
"(1~;J;:l:i~:~illuq¡.5,l!tion of the assignee's rights to the land or resources.
. .~.;--" .:'."...~<' '.:~. .,....."""',..~. .
Jor.pµblicinforuUrnon in SUpport of notations.,madc onJand,SIaIns
imanag,ement, dispoSal, and use of. public lands and.resourœs.
"¡"'~i;ìäte'F~eral agencies when co~currence is required prior to
ì\'íiÌ'ì'í;~Bli~!lands';or resources.
:(4!}(Q)ili1f'pIqla1Íon!;ft¡om·;tþ.=rd.andlo(,tþ.e'record will be transferred to appropri-
>aI!'Æì~f;State.í.aQcalio(foreign'agencies, when relevant to'civil,criminal- orreguJa-
""toÆY."m.vesþg;i,t!.pns;¡Q;¡;prosecutions.
f:.~..:":.''''''''-~~'i!';'''':'\~~'':'-'_..."'~.''':':' .... .
M.WING'~ØRMA!FIØN-If-al1"requested',informa-
,';tiolioijS\¡Jjo·~~thê~~ignmenf'm8ymobbe'approved~ 'See:·regulations at
.:'43:r,eER!f;Giô~p.s~3100:;and~'3200,
':'":':;Y;":"";!;~fr;,F :,\;;:;{¡;~ Tear
__Tœr ___ __ ......,'_.,:--'__,-.,,_ _ _ __"_'__'-'_'_"':"--:0"__ __'__:''----- _ ___ _ _ ___
Part A (Continued):' 'ADDmONAL SPACE for Names and address.es ofadditionaLassignees-,inJtem No.1, if needed, or foc Land Description in Item No.2, if
needed.
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PART B: CERTIFlCAffiJo.NANDHEQUEST FOR APPROVAL
1. T ¡e Assignor certifies.as o.wner .,( a1 inlerest in..tj¡e above ,de.~ignaled.!ease Ihalh,e/she hcrebyassi,gus to. the abo.ve as~i,gnee(s) tbe rights specified above.
2" ,,\ssigne,e certifies as follo.ws~ (a).Assignee' is a cilizeu ofthe,UniledSla les;, au asso.~ation o.fsuch :cilizens; a mun icipalily; Dr a co.rporatio.n organized'l1ndèr th~
làws' of.the' Un iled 5.ta.tes, Dr of anyBtale ,Dr lerrito.i-ythereo.f. 'for lhe,a,ssignmen t 0. (NPR-A leases".assignee is a citizen, national, Dr 'r.esideot alien, o.fthe United
S¡tates'oI,"ssoci.'!io,n,:o.f;such:cítizens, natio.nals"resident ali.ens;,o.,r private"public or',mun.icipal co.r-pontions, (b) Assignee is not.co.,nsidered a minor,uoder tho
laws: o..cihe,State in-wh:ï.ch,the,]ands,covercd by.this,aS'\lgn,meM:a.re lo.cated; ,(c) Assignee's chargeable in teres IS, ,direct and indirecl"ÌlJ eacl¡public domain and
a~quiÌ"ed,¡andSsepa~tely.in'tlÌê:samë.¡Stàtè¡,do:"no.hexcëe.¿'2~6iÒ:,áO'-acresin:o.nandgas leases,(çfwbic,h up..to 200:,000 ac.res may bein oil and gas'optio.ns), Dr
3PO,OOOi'acrcs','jß'leasesJn each leas}ng'District.litA,liiii¡¿£':.,of;,w.liii:Ii::ùJi'"to. 20U';000'acres J;l\ay'be ìn.:,o.ptio.ns, iftbis is an oil ani.! gas lea.se-issued·'in'3.ccordance
with thë¡?:Mì'lieraJ.'LeasIhgAct oU.920,:,or'5il.;20:0:'a,~res;in anio.ne Stite iLiiiis is. a g.eotbermallease;' (d) All, parties holding 301) interest in "the assignment are
olherw:!f,~,~,¡n, ~011l:l~ Jance-,wjdHhe'f.egu12:I'iolts;(,4,:3:'eF-R-'Grou'p·3100:'or 3200) a nd"tl1e authorizing AcIS; "(e) Assignee iSln corn plian'ee with recl2malÍoD'
T~~u.ìrem~ ]_~:(or,a,,!(1;',~äe(at.oilanctgas, lèase:h.ol~~~gs, as re.q,uire~ by sec.' 17(g) o.f.1be,Mineral' Leasing Act;, and (f) Assignee rs not In violation of sec. 41 of the
,;;:~~,:~:er '~:<;;::';_ :.:\,:'~;r;~~\·' ,;;;.'Jt~tz;~j;:;;';:\~)Ä~:;;'::;';-jt:;~';Þ~::;i:'¡~:;~i';"'.~ ,,:!;~j;~}%;~~1~;'::~.,,~ :::';::>:"7: ' ,'" .' .
3~ '"" :r11:j's:{åssFgiim¿nTicònsii"t)i,(¿i'â"cë;é:þl~;Ìt:ce~M~.al!~~p:Þ,llahl,e·,tcnns,;coò'diiions,stipùl:uions and restrictions, pertaining to tbe leue described
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Fo.r geotherma!:as.Si~,nments,an ov.e~r.iding,roya1ty'ma~ not be less tban-one-fo'urth'(1I4) oConé percent of tbe value of o.utput; nor grea,ter than 50 percenioC the rate or
roya It{tl'u 0.:10. tbe,:UnTted:States'when,lbísassigpmentis added,loa!l::prev,iou~Iy.,~r.eatedo:verriding royaHies..,<43 CFR 3241). ,
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I certify;,tha.t'the' statements made hereÍll by me are troe. complete,. and correct to the best of my knowledge and belief aud are made in good faith.
day of """'-~~
ExecÍJ.~d"this
Frank A. Mau
Nameqf .Assignor" as' shown on ,current .lease
ksi~~~:' ..,"~~ ~~. J1..' Yv\ ~r~?nt ,
or 'Fr ank A. Ma u (Signal11re) ,
Attorney-incfact
2ß165
(Sigg.ature)
Preakness Drive
(As:;ignor' s Address) , ;":;
Oaks Rarich·,. TX; 7801 5
(City) -<S,tate)
",(Zi¡¡,' Code)
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Fai:¡;
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~Q~.
, Bryan . au
or
Execüted this
day of )~__
,~200~
~^^-
(Signature)
,Attorneý:-in"fact
~~j.~
(Signature)
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Public ~porting bu:de':l for this form i~estimat~d to average.30 minutes per r~ponse including the time for Jviewing'instructions, gathering and maintaining data, and
completmg and reVlewmg" tb,e fonn. Dlirect comments regardmg the ,burden estimate or ,any other' aspect ,of this form to, U.S. Department oftþ.e,'lnterior Bureau, of La d
Manag~ment(I004:-003.4), ,Bureau Clear.a.nce Officer , (WO-63QMtv!.airStop,.40U..s,1849ìc:.str.êeit;',]}LW.,WaSiiington, D.C. 20240. ,n
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T.itle :18~J;S, C: Sec.,l 00 ~ n;takesit a crilTle for any person knowingly. and will.fuHy to ,make:to; any;{Department or agen~y of the Urúted States aný false fictitio ftaud I
statements or representatIOns as to, any matter within its jurisdiction. " , , us or u ent
NOTARY ACKNOWLEDGMENT
('0(;034
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 comnùssion expires: August 1,2009
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[' THEDAA. PORTER - NOTARY PUBLIC
COUNTY OF STATE OF
SVIIEETWATER WYOMING
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Th da A. Porter, Notary Public