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Home My WebLink About947513r ul tll Jvv, (Februcryzo, a, DEPARTMENT OF THE INTERIOR INIFRIOR,-BUREAU OF LAND MANAGEMENT E 4A'4jM y~tO{I)}MARhMANMENT OF RECORD TITLE INTEREST IN A jOR OIL AND GAS OR GEOTHERMAL RESOURCES Jay 22 f / Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) ,i 1\4 Fu Act for Acquired Lands of 1947 (30 U.S.C 351-359) r 0MINGeothermal Steam Act of 1970 (30 U.S.C. 1001-1025) C! YES";prtment of the Interior. Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) Expires: October 31.2004 Lease Serial No. WYE- 07798C Lease Effective Date (Anniversary Date) New Serial No. Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT Assignee* SEE EXHIBIT "A" Street City, State, ZIP Code C- Gi,282 *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) KROH 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 7 This assignment conveys the following interest: v Land Description Percent of Interest Percent of Additional space on reverse, if needed. Do not submit documents or agreements other than Owned Conveyed Retained Overriding Royalty Similar Interests this form; such documents or agreements shall only be referenced herein. Reserved Previously reserved or conveyed a b c d e f Township 26 North, Range 113 West, P.M., Wyoming SEE EXH IBIT "A" -0- -0- of rec Section 3: SW1/4 SE1/4 Section 10: W1/2 SWl/4 containing 120 acres rT1 .c~ 4T'i ~C3 ~ Vrl r71 Q1 RECEIVED 6/2/2009 at 11:52 AM '1F r-- < - rr1 1 :X RECEIVING # 947513 BOOK: 724 PAGE: 282 c-1) JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY MR RI M ItsF nNl Y - DO NOT WRITE BELO W THIS LINE UNITED STATES OF AMERICA ord This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or quitable title to this lease. Assignment approved for above described lands-, ❑ Assignment approved for attached land description Assignment approved effective MAY 0 1 2009 ❑ Assignment approved for land description indicated on reverse of this form. nnog `KP AP _U By (Authorized Officer) (Title) (Date) (Continued on reverse) FUR I: 0283 PART B - CERTIFICATION AND REQUEST FOR APPROVAL 1. 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. 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 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. 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 made in good faith. Executed this 3RO day of 20 a~ Executed this day of 21 Name of Assignor as shown on current lease Kearns Tribune Corporation r Assignees Assignor vers is Public reporting burden for this form is estimated to average 30 minutes per response including the time Fitt reviewing, instructions, gathering and maintaining data. and completing and reviewing the. fort. Direct comments regarding the burden estimate or an)- other aspect of this form to U.S. Department of the Interior. Bureau of Land Management (1004-0034), Bureau Clearance officer, (WO-630), Mail Stop 401 I-S, 1849 C Street, N.W., Washington, 1W. 20240. Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency ol1he United States any false. fictitious or fraudulent statements or representations as to any matter within its .jurisdiction. EXHIBIT "A" Attached hereto and made part of Assignment of Record Title from: Name Kearns Tribune Corporation Percent Owned 11.111111111 to: Name Alpine King Inc 1257 Third Avenue Salt Lake City UT 84103 Ivers Oil Company LLC I I 1 E Lincoln Road Ste 4 Spokane WA 99208 Kearns Campbell Investments Co 217 Cedar Street #286 Sandpoint ID 83864 Dated / Z 3 2008 Signed for Identification: Kearns Tribune Corporation Percent Conveyed 6.99999999993 2.88888888886 1.22222222221 By: U STATE of Utah )ss 4r C 285 COUNTY of Salt Lake On the Yd day of December 20U, before me p rsonally appeared Jack W Gallivan who being by me duly sworn, did say that he is the , of Kearns Tribune Corporation and that said instrument was signed in behalf of said Corporation, who duly acknowledged to me that they executed the same. My Commissions expires: August 30 2011 Residing at Salt Lake County 4 STEPHANIE BROWN Notary Public Mate of Utah My Commisalon El Ifse Auqust 30t 2011 575 a8t 4000 0 $10 0!1, AAIf I,Ahg AIF , UT 44111