HomeMy WebLinkAbout948722FORM 3000-3 UNITED STATES FORM ArjPiwvty
(January 1996) DEPARTMENT OF THE INTERIOR OMB NO. 1004-0034
BUREAU OF LAND MANAGEMENT Expires: September 30, 1998
ASSIGNMENT OF RECORD TITLE INTEREST IN A
L VOR 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)
1 t. t_..
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
t1 lp-pnttYmd4l'`oflblte Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT ~1 000 9
1. Assignee* DRW HOLDING COMPANY, LLC
Street 700 LOUISIANA, SUITE 1100
City, State, ZIP Code HOUSTON, TX 77002
*If more than one assignee, check here El 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) X❑ Oil and Gas Lease, or F-1 Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) Record Title, 7X 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
than this form; such documents or agreements shall only be referenced herein.
a
TWP 22N, RGE 1112W, 6TH PM
SEC 7: LOTS 7, 8, SWANE/4, E/2W/2, W/2SE/4, NEASE/4
SEC 18: LOT 5, NWANE/4, NE/4NW/4
rl. i • f 6'. n S~,t 1. 6:
554.17 ACRES, M/L
LINCOLN COUNTY, WY
Percent of Interest Percent of
Owned Conveyed Retained Overriding Royalty
or Similar Interests
reserved
or conveyed
b c d e f
0.66667%
OF WTHS
0.66667%
OF 8/8THS
Lease Serial No.
WYW 0310649
Lease Effective Date
(Anniversary Date)
8/01/64
New Lease Serial No.
NONE
RECEIVED 8/3/2009 at 1:03 PM
RECEIVING # 948722
BOOK: 729 PAGE:9
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or
equitable title to this lease.
❑ Assignment approved for above described lands;
Assignment approved effective
By
(Authorized Officer)
Assignment approved for attached land, description
Assignment approved for land description indicated on reverse
of this form.
(Title)
(Date)
Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in Item No., 2 if needed
11,,;10 SOILO
THE STATE OF TEXAS
COUNTY OF HARRIS
BEFORE ME, THE UNDERSIGNED AUTHORITY ON THIS DAY PERSONALLY APPEARED GARY WINSTON, ATTORNEY-IN-FACT FOR
ESTATE OF DIANE R. WOLF, KNOWN TO ME TO BE THE PERSON WHOSE NAME IS SUBSCRIBED TO THE FOREGOING INSTRUMENT, AND
ACKNOWLEDGED TO ME THAT HE EXECUTED THE SAME FOR THE PURPOSES AND CONSI ERATION THEREIN EXPRESSED.
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE ~ DAY OF J0 La len , 20017,
LOUISE R WONZER
My Commission Expires Y UBLIC IN AND FOF THE STATE OF TEXAS
June 15, 2012
D REQUEST FOR APPROVAL
The assignor certifies as owner of 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
associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Assignee is not considered a minor under the law 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; and (d) All parties holding an interest in the asssignment 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 transfers, an overriding royalty may not be less than on-efourth 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 day of a- 200 tf Executed this day of
Name of Assignor as shown on cue t le se ESTATE OF DIANE R. WOLF
Please type or print
Assignor Assignee
GARY INSTON, ATTORNEY-IN-FACT or (Signature)
700 LOUISIANA, SUITE 1100
(Assignor's Address)
HOUSTON, TX 77002
(City) (State) (Zip Code)
(Signature)
,19
BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 30 minutes per response, including the time of 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, Bureau of Land
Management, Bureau Clearance Officer, (DW-110), Denve Federal Caner, Building 40, P.O. Box 25047, Denver, CO 80225-0047 and the Office of Management and
Budget, Paperwork Reduction Project (1004-0034). Washington, D.C. 20503.
Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency of the United states any false, fictitious or fraudulent
statements or representations as to anv matter within its iurisdiction.
Attorney-in-fact
'U.S. GPO: 1992-774-017/67023