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Forn1300Q.3 \\'\í. \\'\:,,::¡xy: UNITED STATES
, 'I: -i(Mt1,i¡~.O~~\\\\!\t.,t\J\)t\'\~ DEPARTMENT OF THE INTERIOR
X:';':~~0 ~:S \..,,, , . \.)\J BUREAU OF LAND MANAGEMENT
\)\)\" '.. \ (J i\~1 Cj. ASSIGNMENT OF RECORD TITLE INTEREST IN A
'J.§\S}"'~\\ ,_,;~E~E FOR OIL AND GAS OR GEOTHERMAL RESOURCES
",-- \ 'iJ \-. \~G
~':\ t.. \..; \..~ \11 '{ O~J\ Mineral Leasing Act of ]920 (30 U,S,C, ]8] et seq,)
\-: ,{ l¥.\h-' ' Act for Acquired Lands of ]947 (30 U,S,C 35] - 359)
C\~\- Geothennal Steam Act of ]970 (30 U,S,C. ]001-1025)
Department ofthe Interior Appropriations Act, Fiscal Year 198] (42 U.S,C, 6508)
000821.
FORM APPROVED
OMB NO, 1004,0034
Expires: April 30, 2009
Lease Serial No,
See Attached Exhibit A
Lease Effective Date
(Anniversary Date)
New Serial No,
l. Assignee* Chevron U.S.A. Inc.
Street P.O. Box 36366
City, State, Zip Code Houston, TX 77236
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
1a. Assignor Chevron U.S.A. Holdings Inc.
"If more than one assignee, check here 0 and listthe name(s) and addressees) of all addtional assignees on page 2 ofthis form or on aseparaœ attached
sheet of paper.
This record title assignment is for: (Check one) [{] Oil and Gas Lease, or D Geothennal Lease
Interest conveyed: (Check one or both. as appropriate) [(] Record Title, 0 Oveniding Royalty, payment out of production or otl1er similar interests
or payments
2, ll1Ís assignment conveys the following ù1terest:
Land Description Percent ofInterest Percent of
Additional space on page 2, jf needed, Do not submit documents or agreements Owned Conveyed Retained Ov.en:idÌ1~ Royalty
other than this form; such documents or agreements shall only be referenced herein, Sllmlar nterests
Reserved Previously
reserved
or conveyed
a b c d e f
See Attached Exhibit A
This Mass Assignment of Record Title from Chevron U.S.A. Holdings Inc.
to Chevron U.S.A. Inc. shall be considered effective August 2, 2005.
RECEIVED 7/1/2008 at 10:55 AM
RECEIVING # 940216
BOOK: 698 PAGE: 821
JEANNE WAGNER
INCOLN COUNTY CLERK, KEMMERER, WY
L
FOR BLM USE ONLY· DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
This assignment is approved solei)' 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 lands;
:~P' 0 ifí) i ?rlf)Ò
,M r-, ',I }~ dA 0
'i;'~~;¿!;'1 ;~S~l·~·~~~?·~J\'~·
G1'Assignment approved for attached land description
Assignment approved effective
D Assignment approved for land description indicated on reverse
ofthis form
m! e~""i1t'J}n'Et. tOV'0~;t
Bureau of Land ~lanagement (BLM)
(Continued on page 2)
(Title)
~t~R 2 1 2008 ,
(Date)
" /; ..I~O " """ ,~
kA.H\ U i,..,M., ",t.,''!.,'! f.::Y ,f\~j¡¡'~..!~R
" r.,.,,\,¡~..,,~~nnL.·
By
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,
000822
PART B - CERTIFICATION AND REQUEST FOR APPROVAL
\, 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 ofthe 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 bysec, l7(g) of the Mineral Leasing Act; and (I) Assignee is riot in violation ofsec, 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
herrin,
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
y::Dl
day of
March
20~
Executed this
4Itl
d f March
ay 0
20~
Name of Assignor as shown on current lease Chevron U.S.A. Holdings Inc.
Name of Assignee: Chevron U.S.A. Inc.
(Please type or print)
Assignor
or
Attorney-in-fact
Assignee
or
Attorney-in-fact
(' .
;i:nat~~,
(Signature)
P.O. Box 36366
(City)
(Assignor's Address)
TX
(State)
77236
(Zip Code)
Houston
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)
(Forni 3000-3, page 2)
CORPORATE ACKNOWLEDGEMENT
000823
STATE OF TEXAS
}
}
}
COUNTY OF HARRIS
This instrument was acknowledged before me on f\tfiRc...\\ 4 , 2008, by D. L. Sleeper
as Attornev-in-Fact of Chevron, U.S.A. Holdings Inc., a Delaware corporation, on behalf of the
corporation.
My commission expires:
Q-/à-./9010
~\'IU""I.
$-;;~~~.'~r.#:~. TONA R. ClAYTON.SARNIAK
!Ooõ'¥. .""~
i i ": Ë Notary Public, State of Texas
'(~~ ... .~~~ My Commission Expires
""f,f,{,~~'.' September 12, 2010
STATE OF TEXAS
}
}
}
COUNTY OF HARRIS
4
Attorney-in-Fact of Chevron U.S.A. Inc.
My commission expires:
~ - \ ~- .00 10
~\"'II""I.
t$~.~~·'~f.~ TONA R. ClAYTON-SARNIAK
! )J Notary PUblic: State of Texas
~. jc' My Commission Expires
',f,M,', S.prOmb.r 12, 2010
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