HomeMy WebLinkAbout939747
Form 3000-3
(January 1999) ,
"UNITEn STATES,
DEPARTMENT OF THE INTERIOR
BUREAU:OF'LAND:MANAG;EMENT
FORM APPROVED
OMB NO. 1004-0034
Expires: December 31, 2001
ASSIG~MENT,OF RECORD TITLE INTEREST INA
LEASE FOROIL:AND,GAS OR GEOtHERMAL RESOURCES
Lease Serial No.
W 05923
Lease Effective Date
(Anniversary Date)
06/01/51
New Serial No.
(.100041.
Mineral Leasing.Act of 1920 (30 D.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 D.S,C::. 351-359)
GeotheI1I1al SteamAct of1970 (30U.S.C. 1001-1025)
Department of the Inteqor Appropriations Act,·.FiscalYear 1981 (42 D.S.C. 6508)
Type or prlnfpl:ainly In Ink;and sign in Ink.
'PÃRTA: ASSIGNMENT
1. Assignee* Bryan A. Mau
S~t 7437 Dallas Drive
City, State, ZIP Code . Aus tin, TX 78729
*If more than one assignee, check here Oandlistthenamè(s)<0d address(eS)ofãll additional assig~ees on the reverse of this form. or on a
separate attached sheèt of paper; , . ,,', ,
This record title aSsignment is for: (Check one) fXloil and.-GasLease, or 0 Geothermal,Lease
'Interest conveyed: (Checkor¡ß or both, (!.j appr;pria;eJ¡!i{JRecord~1'itle, G3'Ov~rriding Royalty, paYment out of production or other similar ,
" .,~~re~t:;. 0LIDi~C<.l!Ý>
:' .~' "'.-'.'" . . ..;, '-~-·'I"".I ,...~-.: :',:'; -,;"""'.",.:"':::!'~:",~.:"~' -t, ;'.. :..~; . ;' .
2. This assi ent eünve s'the:'fdllbwfud.ìite~¿;s't:t:'¡~:; ;;":~':,:\;::,:;:':' ~~::->:":':?':C:;":;':;',;:::;;i;;,:t;~',,;::;":;;'h:)w./:; ;:;;:;::;'(',{'{,: :';~: .,:. ,''-' ':"', . , ,;, ' :',' f""¡!' ,"."C ','.
A~tiona1 space on reverse, ifneeded~'::~;;;~?~~#tz~r;';~~~;;rs'Òfuet,~:: ,':';~:·'.~~]?i:?~:~:::~res~~::~ ":. ;~':'.~~it;~~r:~
this form; such documents or agrn;mentssha11 onlY'be'~fe~E-c;eä:'heJ:em:;, ' : ,;; .,,',
,-, t-
, ,Reserved
Previously
reserved
or conveyed
f
,,'
..,'. .,
a
,b
c
d
e
-z
Township 22 North, Rang~ 112 West, ~3125
6th P.M.
Section 9: S 1/2
Lincoln County, Wyoming
Containing 320~OO acres, more or less'
.3125
None
7.
RECEIVED 6/13/2008 at 10:27 AM
RECEIVING # 939747
BOOK: 697 PAGE: 41
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
EO Ral:MUS~:ON,~Y--DO:Ng:r.W~ITE,BELOW THIS LINE
".' ,',,' ',.UNUE¡j:STATES<.oP:ÄMERrCA '
This assignment is approved solely for administratlvepurpoSes. 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; 0 Assignment approved for attached land description
Assignment approved effective
o Assignment approved for land description indicated on reverse
of this form.
By
(Authorized Officer)
(Title)
(Date)
-. - ~".-
... -. ~ ...- -.- ~... -- -.- ,-_. -.. -.
Tear PARTC: GENERAL INSTRUCTIONS Tear
1. Assignor/ Assignee(s} must complete Parts ALand A2 and PartB. .Åillpartiesto 5. If any,paymcnt,out of production or sÍInilar intert:sts, arrangements or payments
assignment must sign as follow8~ The,assig:nor(s) must manually>sig:n.-,3. or;iginal,·lulve, previously,::been:created'ioutoftheihterest ,being'assigned; or, if any 'such
copies and the assignee(s) must manually sign atleast .iofth~30riginal copies. pa.ymcnts;orinærestsarereseryed IlIIder-tlùsas&Ígnment, inclnde,aiStatement giving
File three (3) completed copies ,of this.fonn,in, the ,proper..BLM,off¡.ce.for;cach full dctÍrilsas to amount, ' method ofpaymcnt, andothcr pertinent terms as provided
assignment of recordtitIe. For a transfer of:ovenidirig, roylllty futerest,paYlncnt under,43; Cl'R 3106, 3135¡ "or" 3241.
out of production or otbc,r similar ,interest orpaymcnt, ,file"one (1)ri1anwiIly signed 6. The'lease account'must''¡'c;mfgood'sUlnding'before this· aSsignment 'can' be ap-
copy of thiJ¡ form. Thercquired filing"fee (nonrefundabJe),must,accompany'the 'proved;'as':providcd.,under 43"CFR ',3106l\1ld"3241.
ass!gnment.File assignment within ninety" (90) days afttr,date öfexccution.of: 7. Assignment, if approved, takes'effect on the first day ,of the month following the
assIgnor. datëof'fiÌing in'tlie'pr¥''BtM'offii:e. ,If a bond is necessary', it must be fur-
2. ¶w form, must be used for each Jease being affected by this assignment. and 'IÛßhc::.if ïJrli:>ni; '8pproYaIofthe . assignment. , '
for each type of intçrest conveyed. ',' " , 8. ApprovaI of assignment,ofrecordtitleto 100% o{a'portion of.thc'l~ Jands
3. In Item No. 2 öfPart A, dcõCribe lands'affected (See 43 CFR,gl06,'J135/or crc:atèSSéparate'ieasesöftlf reiaínedand the ~~pó1'tióiïs,but tIoesDOt,c :umge
3241). Fòrcolumns 'b, c; d, ande, enter'the"intercshxprcssed:'lUia pcrtenb1gethé'te~ 'and conditions 'of the lease anniversary dáte forpurposcs ofþayxncnt
of total interest in thelcasc;:e.g., if: assignor assigns one, quarter 'of a 20% in-of annual.,¡:ental. ,
tercst, enter 20% in. oolUIDD'b, 5 % in ,column c, and '15 % in column d. 9; ,Overri~g'royaIty, payÌnent out of pioductionor other similar ~of transfeI'S
4. If assignment ,is to more than one assignee, enter,eachassigncc'sruune across mUst be,filecLwith BLM, but will be accepted for record purposesonIy: No offi-
columns d, ,e, and f next to the rcspcctive interest being, conveyed. Also list names ciál approvlll' will be given.
ßM Arl.rl,..,..~~ nf Anv nr\rf1hnnal QOII!;~t:'" ......'" """"''-_ ",..ç .\"';n .f'....--. ...... ....... ... ............_.....
~ ~ -.--
PAPERWORKREt ¡\C;r.sTATEIv.J:.ENT
1. Thisjnfonn!liîon is DeJng.eoJJected' pursuant,to,the law.
2. This' !information'wilf be., used, to create and, maintain, 8: recordof."oiL and-
g~/gþQtþ.erml\laease.activity. .
3,;R~p'OIl$.MQ_Íþ,iS·J:e-qllest;is:required to,:obtain ,benefit., , ":""";1't~';'
BLM-,w.o~Id:lilce'youttœknow that\you do not'have to respond tô'tliiš!bfaríyf¡¡tJí6?
Fede~LiJ.g~ncY sPQnsore.d::infonnation' col1ection: unless it,dispJaysta;currently'
vali?-Q~B~,cC\I\~()I'.numþer, ., .'. '" '
NOTICE'" ",,,"',~""" '.'<.
Th~,,P,rl..v~9Y.,AS~¡9f;,\Q74'~91~e.,regulati,9n, in.4~-CIµt~.48@;;w:p'yiq~~ !.t.~y.Pl\\i~;'
fu.r:J:P.SIie4't!.\':#:ä¡~9W~~,jnfp'~on,in.connec:üQn¡with-'lDf~~tion:\~1~:):?~this
oiLand::g¡t~j.!?o~wa.t;,I~,;,~cc;ord"t1t1e"aSS1gnment..appli.c¡úJ.Qn.,: ',: :';~':' .:..\),;.,;:.,
'"....... ",. .:. ...._. ~.' '. ..,~~:. ,_..,.,." ";,- ....:,.'J~~...;..;::.~:.
AUTH,().lU'tY;:3.0~~gr;:s~t~ ,18(et"se<!; 30U~S.C.,.lÐQl."i:1D:~~;42,U..S;·S~~6,5Ø8;
:.·:·.~"i:::>'¡.,'.,:·:~,,·"I~::,J'c¡,(,,;,~';-" -~:-..r.~ .\. :.' \ ..¡ .,. ',':}~~' -'.. o'!::~:J2-:"_~_
PRIJ::{ÇIPAL,p.i:tRP,Q~E,;-~~~Ünfor¡JJ,ati,Qn;is,to;be,us~'1.I><,~~s,.œCDrd::tiµ'e;'1IS-
sig¡unc:nts:for~o.il,Jw.d~gas¥geath.~~ources' Ic:asc:s. "
'ROu;nNE~USES:.
, L"00042
·(I)-.']J);,a$,¡juc:liçl!.tionof the assignec:'srights to the land or resou=.
. ~~iì. :"~" .....:.~".,~.'....;;:::.~,o;¡,:I:.. .
.G>~,,"'''!';R¡for-publicinfo~tio~ in sup.port of nøtati?DS.made onJandstatus
,;IfC,o , j C;,;JDanag,cment, disposal, and use of public lands and;',rc:sources.
. 'E~eral agencies when concurrence is required prior to
'li¿Hands"or resources.
;(~)(5)'¥ßrmatioD.;\Ü.i9m\the>.rc:cordandlor<the'record will be transferred to appropri-
.~;ai~'Stat.ci$lQc¡ilior:foreign'agencies,when-relevant to 'civil, ,criminal' orxegula-
to~!,\V: ' ·ë~i¡,qp:ProsecutioDS.
~Y,JIlING"ThIFORMATIeNo-If;an.'requested',infonna-
,,:, . ';rasi;ignment:\may.~nobbe'approved~ 'See:'regulìI.tiODS at
,;43iteER!iGÏ\<i.IfP.s~ßl00'~and;'\3200,
Tear "l'ea;:~l~:/:f-:: .:'i.~i~ ',{;5',':"':; Tear
. - - - - -- - - -:...._,~'~.-.,-:'!- - - --..-.- -'-'-'~-'~'-'- - -.---,:", --- - - - - -- - - - --
Part A (Continued):' . ADDmONAL St'ACEfor Names and addresses ofadditi~naLassignees.in,Item No.1, if needed, or foe Land Description in lrem No.2, if
needed.
.' . ". "N'·'-·.~ ~..... "~
't"..
'~i'.f'.,. '". .
". ,J'" -~~.'. "
·'r..:;
..,....
.. ',"
I.:' ';,) :.
'J..
..;;;
1.
PARTS: CERTIFICATION AND 'REQUEST FOR APPROVAL
The AssIgnar certifies.as owner ·,f a~ interest ¡n..the abaved,:~[gitatcd,lease that he/she bcreby assigns to. the above as~i.gnee(s) the rights specified above.
I>!ssignee certifies IS fallows~ (a),Assignee' is a citizen af'the,United Slales;, an assoe¡ialion af such ,cilizens; a mun ic!pality; ar a carporatian argaDizeduDdèr th,
laws' oCthe,Un ited Stales. or: of anyState or territorythereaf. 'Far the.,a,Ssignmen I aC:NPR-A leases,,¡assignce is a citizen, nalianal, ar 'resident alien, oftheUnitec
Sbteso,r,assací,tion,of:such:citizens, nationals,rcsident ali,ens:,a,r private, public or':municipal c-orporations, (b) Assignee is notco,nsidered a minor,under tbt
laws:oCìhe,Sta te.ínwh,kh,the]ands:c~vercd by.this,a~tg~,!II:~~~:)~re located; (c) Assignee's chargeable interests, ,direct and indirect"il) each ,public domainaQc
ai'qu'ièed,landssepa1'3.telÿ,in'llie,same:Stàte"da,naEexcew'24(S:Q:~'O:acres in'a,il.and,gas leases,«)fwhic.h up to 2'0'0;0'0'0 ac,res may bein oil and gas'options) 0
3PO,00'(~:;"acres"ln :'leáSes'.Ìn each leasiitg'DistÏ'ict. n:~Alâslt&:.pr,;W¡¡li:IÌ:·.úJi'to 200;0'00' acres !,MY' be in,~options. if this is an oil a niJ gas lease' iSsu~d;'inaccorda~c.
with th~;'Mïri.eran.easii1gActof.192Q"or;51,,20'O:a,~resJn anio.ne Stile icihis is a g~other.mallea·se;' (d) AI!, parties holding al) interest ¡n"the assignmen't an
otherw:~~,~:,ínc0l1!:p ja!lce',wJth,the';regul2:Hons{43:'eF'R:'Grau'p'31'OO'or 32'OO)and"th'e authorizlng Acts; ·(e) Assignee kin compliao'ce wilh reclamation
'requ¡ri:~~:n:IS:for"a,,!(F.,cäe[aL·Qiland:,gas:lease':boldings,asre.quired by sec.' 11(g) of,the.Mineral' Leasing Act;,and (C) Assignee is Dot in violation of sec. 41 of thl
Mine . 7:~;~~~;:,~ft:.t':.;;;.:';[;;.;." .;.:~ '''t:·..'t;~~~~~;''\::;;~::;¡~;";ç:i";>'f~;¿~;,;''·':..:1;¡~;~;;;'~I~,Ò::~~c''.:;~;:::::~,{:' , .. " '
'~(~"'t9~IS1a:ss og'nllienVcoßsh, ,cc,ep.t,a'n:c,e"~J:,alt..~,p.¡~b.cå.b.le'te'nn's,'coni:llt10ns. stipulations and restrictions, pertaining to tbe tease describe
2..
.;....
3:
hhreìn.
! . "'~.:. .
For geo;iherma~:as.Si~;~ments> an ove¡;riding.royal1y ma~ nat be less than'one-fo'urth '(1/4) oC-onè percent,af the value of output; nor grca,ter than 50 percent of the rate 0
royally' þue:lo, the,:JJn'itedStates'when, Ihis assign mentis added"to al1:'prev,iously ,cr.eatcd·overriding royaHies (43 CFR 3241).
~, '.. ,v· '...... ,
day of '1l- &A '+€-
,EC 20~
I certif)fthat 'the' statements made herein by' me are true, complete., and correct to t,he best of my knowledge and belief and .are made in good faith.
.~.{.. ' -
Exccút~~Hthi~"" ~,;. e. '
S I.M..L
,
.~20~
Frank A.
Mau
Name,qf,Assignor,as shown on.currentJc:ase
, :Q.. . Please type ,or print
À&si&n~/ ,,'.. ~'~ J$- n~ ' ' ',', '
'Fr.ank A. Ma u (Signature) -
or
Attorney-in"fact
Fai:¡;
(Signature)
preakness Drive
(Assignor's Address) ,_
Oaks Ranch" TX; 7801 5
(City) :(~tatC)
,(4p;,f;o,dc.)
2ß165,
,.~,~.~-;
Execnted this
\5
day of
~,~ ~ J;)-!'v-
, or Br n ., au (Signature)
. Attomeý:'ÌD"fact
(Signature)
t~¡~~'
~-,-..~~~.~~,.",_~,...,...c:--,_.,...-
Carol S r:10mps!}n
My Commission Expire!?
O',/'; 0/::'01 0
.,
i!
:1
¡¡
. ._.J
C'·.·'"
,·,.,......,."_.;'n'''.....''~·K·~ . .'., , ..,...__
PubIi~ ~portingbu:de~ for this form i~estimat~d to average 30 l1Únutès per response including the time for r~viewing'instructions gathering and maintai· dat '
comp etmg and revlewmg" the form. Direct comments regarding the ,burden estimate OOlDY other aspe.ct of t,his form to. U S D' f' . nmg a, ane
Mana~me.nt (1OQ4,.0034), 'Bureau CIeamnce Officer ,(WO-63'Q).J'MwrStop,,40 I :LS, T849ìC,Strê'ët; iN::W:,WaShington, D.C. i0240~partment othelntenor; B crean. of Lane
Title:lSt!J.:S,:C ~Sec., 100 ~ makes it a,crime' for any ,person knowingly· and wiIlfuHy to~make'to:any.;Pepartment or agen~ of the United States any false fi titi ftaudul'
statements'or-representattons as to, any matter within 'its jurisdiction. ' " ,1C ous or en.
NOTARY ACKNOWLEDGMENT
County of Sweetwater
)
: ss.
)
L00043
The State of Wyoming
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
MY COMMISSION EXPIRES AUGUST 1. 2009
~~~~~~~-~~~~~~~~
~~---"""~fIW ~ IIt-.I"-""_""'~""L'W_~_
THEDA A. PORTER - NOTARY PUBLIC
COUNTY OF STATE OF
SWEElWATER WYOMING