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Home My WebLink About947511(February 2002) M, NPR 16 X013 DEI TMENT OF THE IN7 EMOK BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A LEAS~6OR OIL AND GAS OR GEOTHERMAL RESOURCES 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) ~g4fltjhe Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) Expires: October 31, 2004 Lease Serial No. WYE-07798A Lease Effective Date (Anniversary Date) New Serial No. 5 ► Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT Assignee* SEE EXHIBIT "A" Street City, State, ZIP Code 02"74 *If more than one assignee, check here Eland 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) KOil and Gas Lease, or ❑ Geothermal Lease Interest conveyed: (Check one or both, as appropriate) Record Title, ❑ Overriding Royalty, payment out of production or other similar interests or payments 2- This the following interest: Land Description Additional space on reverse, if needed. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein. a Township 26 North, Range 113 West, 6`h P.M., Wyoming Section 3: Lots 6, 7, 10, 11, NW1/4 SE1/4 Section 10: N1/2NW1/4, SW1/4NW1/4 RECEIVED 6/2/2009 at 11:41 AM RECEIVING # 947511 BOOK: 724 PAGE: 274 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Percent of Interest Owned Conveyed Retained b c d. ;E EXHIBIT "A" -0- Percent of Overriding Royalty Similar Interests Reserved Previously reserved or conveyed e f -0= 1 of recori FOR BLM USE ONLY - DO NOT WRITE BELOW THIS LINE UNITED STATES OF AMERICA Th is assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or P u itable title to this lease. Assignment approved for above described lands; ❑ Assignment approved for attached land description na ~ A ~ Z00 Assignment approved effective ❑ Assignment approved for land description indicated on reverse ~ a , ..:~'rp~T4,.PIJ0 'if By (Tittle) (Date) (Authorized Officer) (Co-rranued on reverse) r+ ..3 FOR C 0 17.5 PART B - CERTIFICATION AND REQUEST FOR APPROVAL The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above. 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 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 any one 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. 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 we, complete, and correct to the best of my knowledge and belief and are made in good faith. Executed this day of 20Executed this day of ~ 20 Name of Assignor as show on current lease Kearns Tribune Corporation Assignor Assignees Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Departmcnt or agency ol'the I1nited Slates any false. liditious or t'raudulent statements or representations as to any matter within its jurisdiction. 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 olhcr aspect oflhis form to U.S. Department of tlic Interior. I3urcau of Land Management (1004-0034), I3urcau Clearance Olliccr, (WO-630). Mail Stop 401 I_S. 1849 C Strcct N.W., Washington. D.C. 20240. EXHIBIT "A" U•CU276 Attached hereto and made part of Assignment of Record Title from: Name Kearns Tribune Corporation Percent 11.111111111 to: Name Alpine King Inc. Ivers oil Company LLC Kearns Campbell Investments Address 1257 Third Avenue Salt Lake City UT 84103 111 E Lincoln Road Ste 4 Spokane WA 99208 217 Cedar Street #286 Sandpoint ID 83864 Percent 6.99999999993 2.88888888886 1.22222222221 Signed for Identification: Kearns ibune oration By: Ja . Gallivan, President 1 N ~ o .ten t'f'1 y. Cn w.. C3 U..) O STATE of Utah ) ) ss COUNTY of Salt Lake) 0,02 On the 27th day of February 2009, before me personally appeared Jack W. Gallivan who being by me duly sworn, did say that he is the President of Kearns Tribune Corporation and that said instrument was signed in behalf of said Corporation, who duly acknowledged to me. that they executed the ame. My Commission expires: August 30 2001 NO Y PUBLIC Residing at Salt Lake County STEPHANIE BROWN Notary Public State of Utah My Commission Expires August 30, 2011 576 East 4600 S Ste B-260, Salt Lake Ci , UT 84111 sv a~* rn ~ , v G C1 F r~ r n C:) 3 !C7