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FORM )000·)
(January 1996)
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: September 30. 1998
Lease Serial No.
WYW 0314961
Lease Effective Date
(Anniversary Date)
3/01/65
New Lease Serial No.
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.c. 351-359)
Geothennal Steam Act of 1970 (30 V.S.C. 1001-1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 V.S.C. 6508)
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
1. Asslgnee*
Street
City, State, ZIP Code
lRW HOLDING COMPANY, LLC
700 LOUISIANA, SUITE 1100
HOUSTON, TX 77002
006332
*If more than one assignee, check here
separate attached sheet of paper.
This record title assignment is for: (Check one) 0
o and list the name(s) and addressees) of all additional assignees on the reverse of this fonn or on a
Interest conveyed: (Check one or both, as appropriate)
Oil and Gas Lease, or
o Record Title,
o
o
Geothennal Lease
Overriding Royalty, payment out of production or other similar
interests or payments
2. This assignment conveys the following interest:
Land Description
Additional space on reverse, if needed. Do not submit documents or agreements other
than this fonn; such documents or agreements shall only be referenced herein.
Percent ofInterest
Owned Conveyed Retained
Percent of
Overriding Royalty
or Similar Interests
Reserved Previously
reserved
or con veyed
e f
a
b c d
2% 2% NONE
OF 8/8THS OF 8/8THS
TWP 25N, RGE 112W, 6TH PM
SEC 4: LOTS 1-3, NE/4, E/2NW/4, SW/4, W/2SE/4, NE/4SE/4
RECEIVED 9/8/2008 at 11 :56 AM
RECEIVING # 942045
BOOK: 704 PAGE: 332
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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FOR BLM USE ONLY·· DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
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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 lands;
Assignment approved effective
D Assignment approved for attached land description
D Assignment approved for land description indicated on reverse
of this fonn.
By
(Authorized Officer)
(Title)
(Date)
Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. I, if needed, or for Land Description in Item No., 2 if needed
THE STATE OF TEXAS
COUNTY OF HARRlS
00û333
BEFORE ME, THE UNDERSIGNED AUTHORITY ON THIS DAY PERSONALLY APPEARED GARY WINSTON, ATTORNEY-IN-FACT FOR
DANIEL WOLF, KNOWN TO ME TO BE THE PERSON WHOSE NAME IS SUBSCRIBED TO THE FOREGOING INSTRUMENT, AND
ACKNOWLEDGED TO ME THAT HE EXECUTED THE SAME FOR THE PURPOSES AND CONSIDERATION THEREIN EXPRESSED.
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE 15TH DAY FJULY, 2008.
LOUISE R WONZER
MJ Commllllon Explrn
Junl 15. 2012
NO
ION AND REQUEST FOR APPROVAL
\. The assignor certifies as owner of 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 of NPR-A leases, assignee is a citizen, national, or resident alien of the United States or
associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Assignee is not considered a minor under the law 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 geothermal lease; and (d) AJI parties holding an interest in the asssigrunent 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 by sec. ]7(g)
of the Mineral Leasing Act; and (I) Assignee is not in violation of sec. 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 herein.
For geothennal transfers, an overriding royalty may not be less than on-efourth (\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 15TH day of JULY 2008 Executed this day of
Name of Assignor as shown on curre~lease DANIEL WOLF
~ . ^ Please type or print
Assignor ~
GARY STON, ATTORNEY-IN-FACT
,19_
(JJ Assignee
or
(Signature)
Attorney-in-fact
. .
(Signature,?'
700 LOUISIANA, SUITE 1100
(Assignor's Address)
HOUSTON, TX 77002
(City) (State)
(Zip Code)
BURDEN HOURS STATEMENT
Public reporting burden for this fonn is estimated to average 30 minutes per response, including the time of reviewing instructions, gathering and maintaining data, and
completing and reviewing the fonn. Direct comments regarding the burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land
Management, Bureau Clearance Officer, (DW-IIO), Denve Federal Cener, Building 40, P.O. Box 25047, Denver, CO 80225-0047 and the Office of Management and
Budget, Paperwork Reduction Project (1004-0034). Washington, D.C. 20503.
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 iurisdiction.
·U.S. GPO: 1992-774-017/67023