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Home My WebLink About945742 FOIDl 3000..3 (May 2006) UNITED STATES DEP ARTMENT 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 351 - 359) Geothennal Steam Act of 1970 (30 U.S.C. 1001-1025) Deparlment of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) 1. Assignee* Emily H. Lauehnor Street 11853 Beneh Rd. City, State, Zip Code Minoula, MT 59808 la. Assignor PeCro Atla. Corporalion P.O. Box 281089, Lakewood, CO 80228 .. *Jfmore1bøn ODe assignee, che<Xheœ D and list the name(s) andaddœss(es) of all addIiooa1 œsignees OIl page 2 of this fonn crOll aseparate øttaCbed sheet CÎpapec. This recml1itIe IU!ØÍIIIIIa1t is for. (Ch«k one) ø Oil and Gas Lease, or 0 GeoIhennallease lnttmItoonveyed: (Chedç one or báh, as awroprlate) 0 &coni Tille, 0 Oveniding Royalty, payment out of¡roduclíon or otber similar Íßta'esIB orpayDll'lis Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT ÜO\:;065 2 This -(!IIDXIIt conveys the foUowing interest: Land Description Perœnt of Interest Percent of Additional space on page 2, if needed. Do not submit documents or agreements Omled Cmveyed Relained Overridín~ Royalty other than this form; such documents or agreements shall only be referenced herein. Similar nterests ~X Previously ronveyeè reserved or conveyed a b c d e f Tcnmlhlp 25 Nortb, Range 111 Wett, 6th P oM. 2.77812% SectIon 17: LotI 1-8 SectIon 18: Loti 5-12 Linoln County, Wyoming Conlabdng 636.45 HI'eI, more or leII. RECEIVED 3/9/2009 at 10:58 AM RECEIVING # 945742 BOOK: 717 PAGE: 65 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY FOR BLM USE ONLY - DO NOT WRITE BELOW THIS UNE UNITED STATES OF AMERICA This _gøment is approved IOlely for administrative purposes. Approval does not warrant that either party to this aøigøment holds legal or equitable title to tbIsleue. D Assignment approved for above described lands; D Assignment approved for attached land description Assignment approved effective D Assignment approved for land description índicated on reverse of this fonn By Bureau orLand Management (BLM) (Continued on page 2) (Title) (Date) Part A (Continued): ADDITIONAL SPACE for names and addreaaca of additional alllgncca in Item No. I, if needed, or for Land Deaoription in Item No.2, if needed. STATE OF COLORADO ) ) II. COUNTY OF JEFFERSON) o")/}dJ -- On tbll ÆS::!- day of .:.JQjìUCÛ'! 1 .2009, personally appeared before me Jamel L. Harden Ill, al Pretldent of Petro Atlal Corpontfon, tbe Ilgner of tbe above IDlmmeDt, wbo duly ackDowledged to me tbat be executed tbe lame. WITNESS my band and ofYIclalleal. My commlnlon expires: r¡ - ;:J..J. -:2 0 1.;.2.. of¡;'da- ~ & Notary Public 0" ('140 ." 066 ~, \II UNDA KAY PRWN NOTARY PUBUC STATE OF COLOBADo MY COMMISSION EXPIRES 07/22/?n12 PART B· CERTIFICATION AND REQUEST FOR APPROVAL 1. The Aaaignor ocrtifica as owner if an intereat in the above designated lease that he/ahe hereby aasigns to the above assignee(s) the rights øpeoified above. 2. Assignee ocrtifiea II follows: (a) Asaignee is a oltizen of the United Statea; an alloolation of suoh oitizens; a munloipality; or a oorporatlon organized under the laws of the United States or of any State or territory thereof. For the allignment ofNPR-A leasea, aaaignee is a oitizen, nationa~ or resident alien of the United States or assooiatlon of such oitizens, nationala, resident aliens or private, publio or munioipal oorporatlons, (b) Asaignee íø not oonsidered a minor under the lawa of the State in whloh the lands oovered by this aaaignment are looated; (0) Allignee's ohørgeable interests, direot and Indireot, in eaoh publio domain and aoquired lands sepørately in the same State, do not exoeed 246,080 aores in oil and gaø leaaea (ofwhioh up to 200,000 aores may be in oil and gaa options), or 300,000 aores in leases in esoh leaaing Diatriot in Alaska of whioh up to 200,000 aorea may be in optiona, if thia íø an oil and gaø lelle illucd in aooordanoe with the Mineral Leasing Aot of 1920, or 51,200 aorea in anyone State if thíø íø a geothermal lease; (d) All partiea holding an interest in the aasignment are otherwlae in oompllanoe with the regulationa (43 CFR Group 3100 or 3200) and the authorizing Aota; (e) Aaaignee la in oomplianoe with reolamation requirements for all Federal oil and gll leaae holdinga as required byaeo. 1700 of the Mineral Leasing Aot; and (t) Alligncc ia not in violation ofaeo. 41 of the Mineral Leaaing Aot. 3. Assignee'a signature to this assignment oonatitutes aooeptanoe of all applioable terma, oonditions, stipulations and restriotions pertaining to the leaae deøoribed herån. For geothennal asaignments, an overriding royalty may not be lesa than one-fourth (1/4) of one peroent of the value of output, nor greater than 50 peroent of the rate of royalty due to the United States when thia aaaignment is added to all previously oreated ovelTiding royaltiea (43 CFR 3241). I oertify that the atatements made herein by me are true, oomplete, and OOlTeot to the beat of my knowledge and belief and are made in good faith. sf' :2/ - 29th dsy of January 20 09 Exeouted this day of ~~d 200L Exeouted thia Name of Assignor aaahown on oUlTent lease Petro Atlas Corporation (please type or print) ~ Aøsígnee ~ or - (Sig ~ Attomey-in-faot P,O. Dos 281089 ^- r\ ~'-w:. SW1a~) President (Signature) Secretary (Asaignor's Addresa) CO (State) (Signature) Assignor or ATTEST: ..~., ÍB f...· (City) 80:U8 (Zip Code) Lalmvood Title 18 U.S.C. Seo.l001 makes it a orime for any penon knowingly and willfully to make to any Department or agenoy of the United Statce any faile, flOtitioua, or ûaudulent atatements or representations as to any matter within its jurisdiotion. (Continued on page 3) (Form. 3000-3, page 2)