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Forni 3000-3
(May 2(06)
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
Lease Serial No.
WYW63819
Lease Effective Date
(Anniversary Date)
07/01/1978
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 3S1 - 3S9)
Geothermal Steam Act of 1970 (30 U.S.C. l001-I02S)
Depar1ment of~e Interior Appropriations Act, Fiøcal Year 1981 (42 U.S.C. 6S08)
1. Aøøignee* Jamea 1.. Harden III
SIrect r.o. Dos 281089
City, State, Zip cœe Lllkewood, CO 80228 18. Assignor retro Atlas Corponllon
r.o. Box 281089, Lllkewood, CO 80228
OÞJf'more 1bøn one IISSp, d1eår.bere 0 IIIJd list the name(s) and øddœøs( es) of all addIionølllS8Ígnees on page 2 of this fonn or on asepørate øIIad1ed
sbeet d'pøpeI'.
This æcord1itle ~ is for: (Ch«kone) [Z] Oil and Gas Lease, or 0 GeoIhennaIl.ease
Interest conveyed: (Chedc one or bah, as a¡;proprtate) 0 Record Tille, [Z] Oveniding Royalty, payment out of ¡roductíon or cè'r similar ínta'œIs
orpay¡neøs
Type or print plainly In Ink and sign In ink.
PART A: ASSIGNMENT
000063
2 This I18SÌgomeot conveys 1hc foBowing intereøt:
Land Desçrjption Percent of Interest Percent of
AdditiooaJ space on page 2, if needed. Do not submit documents or agreements Ü\Wed Cmveyed Retained Overri~ Royalty
other than this form; such documents or agreements shall only be referenced herein. Similar terests
~ PnMously
onveye( reserved
or conveyed
a b c d e f
Township 25 North, Ruge 111 Waf, 6th P.M. 2.77812%
Sedion 17: Lots 1-8
Seedon 18: Loti 5-12
Uneoln County, Wyoming
Contalnlng 636.45 aera, more or len.
RECEIVED 3/9/2009 at 10:58 AM
RECEIVING # 945741
BOOK: 717 PAGE: 63
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
I I I I I
FOR BlM USE ONLY - DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
This lllignment is approved solely for administrative purposes. Approval doe. not warrant that either party to thi.Ullgnment holds legal or equitable
title to thilleøe.
o Assígmnent approved for above descóbed lands; 0 Assignment approved for attached land description
Assígmnent approved effective
o Assigmnent approved for land description indicated on reverse
of t1ùs fonn
By
(Title)
(Date)
Bureau orLand Management (BLM)
(Continued on page 2)
Part A (Continued): ADDITIONAL SPACE for names and addresses of additional aasignees in Item No.1, if needed, or for Land Desoription in Item No.2, if needed.
STATE OF COLORADO )
) II,
COUNTY OF JEFFERSON)
CI ¡)¡ ...-r
On tbll 2..L day of JMtJt1.IVJ ,2009, perlonally appeared before me Jamel L. Harden Ill, al Prelldent
of Petro Atlas Corporation, tbe Ilgner oftbe above Inltnlment, wbo dnly acknowledged to me tbat be executed tbe lame.
WITNESS my baud aDd oMclal seal.
My commlnlonexplrea: 7- J../) -.;ìO ):J.
~Vnd0 ~ f}~'h
Notary Public
Ü00064
1. The Aasignor oertifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignec(s) the righta apeoified above.
2. Assignee oertifies as follows: (a) Assignee is a oitizen of the United States; an usooiation of suoh oitizens; a munioipality; or a oorporation organized under the
laws of the United States or of any State or territory thereof. For the usignment ofNPR·A leases, assignee is a oitizen, national, or resident alien of the United
States or assooiation of such oitizena, nationals, resident aliena or private, publio or nwnioipal oorporationa, (b) Assignee is not oonaiderod a minor under the
laws oithe State in whioh the landa oovered by this aasignmont are located; (0) Asaignce's ohargeable interesta, direot and indiroot, in eaoh publio domain and
aoquired lands separately in the same State, do not exoeed 246,080 aores in oil and gasleaaos (ofwhioh up to 200,000 aores may be in oil and gas options), or
300,000 acres in leaaes in eaoh leuing Distriot in Alaska of whioh up to 200,000 aores may be in options, if this is an oil and gas lease iuued in aooordanoe
with the Mineral Leasing Aot of 1920, or SI,200 aores in anyone State ifthia ia a geothennallcase; (d) All parties holding an interOllt in the aasignmont are
otherwise in oomplianoe with the regulation. (43 CFR Group 3100 or 3200) and the authorizing Aota; (e) As.ignee i. in oomplianoe with reclamation
requiremonta for all Federal oil and gas lease holdings aarequired byaeo. 17(g) of the Mineral Leasing Aot; and (1) Asaignee ia not in violation of.eo. 41 of the
Mineral Leaaing Aot.
3. Aasignce'. .ignature to this assignmont oOMtitutc. aooeptanoe of all applioable lonna, oonditiona, .tipulatioM and restrictiona pertaining to the leaae dcøoribed
herein.
For geothonnal u.ígnmenta, an overriding royalty may not be less than one·fourth (1/4) of one peroent of the value of output, nor greater than so peroont of the rate of
royalty due to the United States when this usignment is added to all previoualy oreated overriding royalties (43 CFR 3241).
I oertify that the statemonta made herein by me are true, oomplete, and oorreot to the best of my knowledge and belief and arc made in good faith.
Executed thi.
29th
day of
January
20
09
Executed thia
29th
day of
January
20~
Name of Assignor as shown on ourrent lease Petro Ada Corporadon
Asaignee
(pleaae type or print)
)~ ;¿ ~\ ~ -;nr..
(Signature)
or
or
Attorney-in-fact
(Signature)
P.O. Bœ 281089
(Signature) Secretary
(City)
(Aa.ignor'. Address)
CO
(State)
80228
(Zip Code)
Lakewood
Title 18 U.S.C. Seo.1001 makcø it a orime for any poraon knowingly and willfully to make to any Department or agenoy of the United States any false, fiotitioua, or
ûaudulent statomenta or repreaentatioM as to any matter within ita jurisdiotion.
(Continued on page 3)
(Fonn 3000-3, page 2)