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Home My WebLink About941281 ÜOô322 . Ponn 3000-3 (May 2006) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A lEASE FOR Oil AND GAS OR GEOTHERMAL RESOURCES FORM APPROVED OMB NO. 1004-0034 Expires: April 30, 2009 Lea~t~ g.3~g1 Lease Effective Date (Anniversary Date) Apr 1, 1983 New Serial No. Mineral Leasing Act of 1920 (30 V.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C 351 - 359) Geolhermal Steam Act of 1970 (30 V.S.C. 1001-1025) Department of the Interior Appropriations Act., Fiscal Year 1981 (42 V.S.C.6508) I. Assignee· John M. Waid Maribelle M. Waid Street 19 Richmond Place 150 Braodway, Apt 406 City,SIate,ZipCode New Orleans, Louisiana 70115 Ia. Assignor New Orleans, Louisiana 70118 *Ifmorc than oncas.~igncc, check here 0 and list tbenamc(s)and address(cs) of all addtionalassignccs on page 2 oflhis fonn or on a separate allaebed sheet of paper. This I\!COId title assignment is fur: (Check one) 0 Oil and Gas Lease, or 0 GGOIhwmaI Lease Interest oonveyed: (Check one or both. as appropriate) GJ Record Tide, EJ Overriding Royalty, payII1ent out of ¡xoduction or other similar ÎntcRsts or paymcnls Type or print plainly In ink and sign In ink. PART Ai ASSIGNMENT 2. This assignment conveys the fullowing interest: Land Description Additional space on page 2, if needed. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein. Percent oflntercst Owned Cooveyed Retained Percent of Ovenid~ Royalty S imil ar Interests c Resa:vcd Previously reserved or conveyed e f a b d Lincoln County, Wyoming T26 N, RIll W, 6th Prin Mer Sec 20: W 1/2 of E 1/2 Sec 29: W 1/2 of W 1/2 1.25% 1. 25% 1.25% 1. 25% C'~ ".i-, ,~ .... ... ~1;~~"r:~ Ç"T".;o.,r RECEIVED 8/14/2008 at 12:42 PM RECEIVING # 941281 BOOK: 702 PAGE: 322 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY I I I FOR BlM USE ONLY· DO NOT WRITE BELOW THIS liNE . UNITED STATES OF AMERICA This usignDleot is approved solely for administrative purposes. Approval does not warrlllt that either party to this USigDDleJIt holds legal or equitable title to this lease. o Assignment approved for above described lands; 0 Assignment approved for attached land description o :::r.:_¡.. f"'I1 .,~ f ~·r¡:¡ % ,_. 2: ( ) C'l r1 :.E:? -< .... qrrJ 3:0 ..-- . 'Z .. P ~..- , '-- - Z(,.. ,i l .....>...~ '"....... c_ <.i .) .. -, ';11.::" I.... ~r- ..... ;:g ~T' .,.. ... ~, 'F~ :i: -1 -",.,." -"-.'" X'" .n.. I.D .. ,:::) ,-~) Assignment approved effective o Assignment approved for land description indicated on reverse ofthisfonn By Bureau of Land Management (/3LM) (Continued on page 2) (Title) (Date) Pan A (Continued): ADDITIONAL SPACE tor names and addresses of additional assignees in Item No.1, if needed, or for Land Description in Item No.2, if needed. úOü323 (J ::r. ,. '., ", rd -< r··" i"'I1 . r XÇ} Z~! mt·! :E -;: -<"'" ofTi 3:0 :z: C") "..) :1> :Ji: I.D C ::;j PART B - CERTIFICATION AND REQUEST FOR APPROVAL 1. The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to tbe above assignee(s) the rights specified above. 2. Assignee cenities as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organiæd under the laws of the United States or of any State or territory thereoC For the assignment ofNPR-A leases, assignee is a citizell, 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 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 geothennallease; (d) All parties holding an interest in the assignment are otherwise in compliance with the regulations (43 CFR Group 3]00 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 ofall applicable tenns, conditions, stipulations 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 aU previously created overriding royalties (43 CFR 324]). I cenify 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 day of 20 Executed this 20_ day of Name of Assignor as shown on current lease Maribelle Waid " Assignor . / .. '/t": ?? ? /.. , ¿ . C2 c:.r ,J' I~ t1.¡. l-t, ,-.(t. _r-"¿? ISil!lUlture) (Signature) Assignee or Attorney-in-filet or Attorney-in-fact (Signature) lfiO Rrn~rlw~y, ~pt dOh (Assignor's Address) New Orleans, LA (City) (State) (Signature) 70118 (Zip Code) Title 18 U.S.C. Sec.IOOI makes it a crime for any person knowingly and willfully to make to any Depanmel1t or agency of the United States any false, fictitious, or fraudulent statements or representations as to any mailer within its jurisdiction. I (Continued on page 3) (Fonn 3000-3, page 2) c:r ':D c.... c::: r·- ';1,..._ ,,~, ........ st~{ . -,~ .~¡¡" "ì-';:'':\ -;¡:- :~:)o. ~ ""1 i~~ .3: .:,~ ~.~.M {~~ ¡·r'r~ :-f.: ::~J ~'?