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BUREAU OF LAND MANAGEMENT
txptres: vcivocr J., Lllvr
Lease Serial No.
WYE- 07798D.
ASSIGNMENT OF RECORD TITLE INTEREST IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
"'~Qd9 APR Act for Acquired Lands of 1947 (30 U.S.C 351-359)
r Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
,bgpaj*ncnt o the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Lease Effective Date
(Anniversary Date)
New Serial No.
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
Assignee*
Street
City, State, ZIP Code
SEE EXHIBIT "A"
-278
*If more than one assignee, check hereEI(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) KjOil 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 assignment conveys the following interest:
Land Description
Ad ditional space on reverse, if needed. Do not submit documents or agreements other than Owned
thus form; such documents or agreements shall only be referenced herein.
a I b
Township 26 North, Range 113 West, 6t' P.M., Wyoming
Section 3: Lots 8, 9, E1/2 SE1/4
Section 10: N1/2 NE1/4, E1/2 SW1/4
containing 320 acres
RECEIVED 6/2/2009 at 11:49 AM
RECEIVING # 947512
BOOK: 724 PAGE: 278
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
neat of Interest
Conveyed Retained
c d
IT "A' -0-
Percent of
Overriding Royalty
Similar ntcrests
Reserved Previously
reserved
orconveyed
e f
-0-
of recort
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 hol& legal or
u itable title to this lease.
❑ Assignment approved for attached land description
V Assignment approved for above described lands;
approved effective MAY 0 1 2009 ❑ Assignment approved for land description indicated on reverse
Assignment of this form.
ISI Kell , Rc4li LAIN EXAMU' ER APP 9 2-00 erts
BY (Title) (Date)
(Authorized Officer)
(Car:ri=c-d on reverse) Q r ii16 S 1y M~~
Y`
Oi~279
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 ofNPR-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).
1 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 day of 20 Executed this day of
20
Name of Assignor as show on current lease Kearns Tribune Corporation Assignees
r n ~
Assignor
pine Inc
A-
rs Oi
tmentf
Public reporting burden for this form is estimated to average 30 minutes per response including the timc7or reviewing instructions. gathering and maintaining data. and
completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S. Department of the interior. Burcau of Land
Management (1004-0034), Bureau Clearance Officer, (WO-630). Mail Stop 401 I-S. 1849 C Street, N.W.. Washington. D.C. 20240.
Title I S U.S.C. Sec. 1001 makes it a crime I'or any person kno%-ingly and willfully to make to any Department or agency of the United States anv false. fictitious or Iraudulent
statements or representations as to any matter within its, jurisdiction.
EXHIBIT "A"
C, GV- 280
Attached hereto and made part of Assignment of Record Title from:
Name
Kearns Tribune Corporation
to:
Name
Alpine King Inc.
Ivers oil Company LLC
Kearns Campbell Investments
Address
1257 Third Avenue Salt Lake City VT 84103
111 E Lincoln Road Ste 4 Spokane WA 99208
217 Cedar Street #286 Sandpoint ID 83864
Percent
11.111111111
Percent
6.99999999993
2.88888888886
1.22222222221
Dated February 27 2009
Signed for Identification:
Kearns Tribune YorporatJon,
By:
Jae . Gallivan, President
STATE of Utah )
) ss
COUNTY of Salt Lake)
s~''~~u+28~
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
My Commission expires:
August 30 2001
STEPHANIE BROWN
Notary Public
State of Utah
My Commission Explros August 30, 2011
1575 East 4500 8 Ste 8-260,861t Lake CI , UT 84111
Residing at Salt Lake County