HomeMy WebLinkAbout942747
1q
Î
Form 3000-3
(January 1996)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT 000595
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-175768
Lease Effective Date
(Anniversary Date)
. september 1, 2008
New 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)
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
1. Assignee*
Street
City, State, ZIP Code
EOG Resources, Inc.
1111 Bagby, Sky Lobby 2
Houston, TX 77002
*If more than one assignee, check here 0 and list the name(s) and address(es) of all additional assignees on the reverse of this form or on a separate
attached sheet of paper.
This record title assignment is for: (Check One) 181 Oil and Gas Lease, or
Interest conveyed: (Check one or both, as appropriate) 181 Record Title,
o Geothermal Lease
2
This assignment conveys the followina interest:
Land DescrlDtion Percent of Interest Percent of
Additional space on reverse, if needed. Do not submit documents or agreements Owned Conveyed Retained Overriding Royalty
other than this form; such documents or agreements shall only be referenced or Similar Interests
herein. Reserved Previously
reserved
or
conveyed
a b c d e f
100.00% 100.00% None None None
TownshiD 20 North. Ranoe 113 West. 6th P.M.
Section 12: NE1/4, NE14NW1/4, NE1/4SE1/4
Containing 240.00 acres, more or less
Lincoln County, Wyoming
o Overriding Royalty, payment out of production or other similar interests
or payments
RECEIVED 1 0/9/2008 at 10:43 AM
RECEIVING # 942747
BOOK: 706 PAGE: 595
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
\, \ '
FOR BlM USE ONLY - DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
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 form.
By
"' C'. -:\,1, .~.~, .. J H.'
'. \,Ji'
(Title) (Date)
(Authorized Officer)
77-1/,/dJ D,,< 3D / / ,7 -6ÓÛ
ûO{)S96
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.
STATE OF
)
) ss.
)
COUNTY OF
The foregoing instrument was acknowledged before me this 4th day of September, 2008, by C. Steven Stacy, as
President of Hoover & Stacy, Inc.
\"'''"11",
",\\ .ç.t\ & S'1:"'"
," O~ .......... -10 "
$'.p "''çpRPOr¡>:';" .J--=:'
~~: ...>-....",.~
:: S· ~ ,.., '. z.. -:
= cAL ':0:
~ 200?: ~
~ \ .,: ~
":. ú~'" *' .... ....
"~Yh ....... "
", OMING ",
"1 \\\
"'fI."'"
~KM
Notary Public
0--/1
WITNESS my hand and official seal.
My Commission Expires: 11 ~ ':l.$~'20 \~
. N Aft U \.:
_STATE. OF
oouNTY OF WYOMING
LAfllAMIE
SIOM ( 1AE8 Apt" 25. aG12
MY
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. 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 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 interest, direct or Indirect, in each
public domain and acquired lands separately In the same State, do not exceed 246,080 acres in 011 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 Minerai 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 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 of all applicable terms, 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 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 mad
Executed this 2nd day of September ,20 08 Executed this ~~ ~ay of
,20
01
Cheyenne
(City)
P.O. Box 2328
(Assignor's Address)
WY
(State)
Assignee ~¥L ~
Att or '~t James C. Fletcher
orneY-1 c
Agent & Attorney-in-FacT
Assignor
or
Attorney-in-fact
82003
(Zip Code)
Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions, gathering and maintaining
data, and completing and reviewing the form. Direct comments regarding the burden estimate or any othe'~~'Òfthíiform to U.S. Department of the Interior,
Bureau of Land Management, Bureau Clearance Officer, (DW-110), Denver Federal Center, Building 40, P.'ó:'13òx 25047, benver, 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 jurisdiction.
*U.S. <;3PO: 1992-774-017 /67022