HomeMy WebLinkAbout952050Form 3000 -3
(May 2006)
1.
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
Qy C aIGNMENT 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.)
\tact for Acquired Lands of 1947 (30 U.S.0 351 359)
t Geothermal Steam Act of 1970 (30 U.S.C. 1001 -1025)
epartment of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Assignee* MRC ROCKIES COMPANY
Street 5400 LBJ FREEWAY, ONE LINCOLN CENTRE, SUITE 1500
City, State, Zip Code DALLAS, TX 75240 1017 la. Assignor
*If more than one assignee, check here and list the name(s) and address(es) of all addtional assignees on page 2 of this form or on a separate attached
sheet of paper.
This record title assignment is for. (Check one)
a
rA
Interest conveyed: (Check one or both, as appropriate) 151 Record Title,
24N120W11,14,23 1,783.57 acs described as follows:
Section 11 All
Section 14 NE /4 NW /4, S/2 NW /4, S/2
Section 23 Lots 1, 4, 5, 8, NE /4, N/2 NW /4, SE /4 NW /4 and SW /4
Lincoln County, Wyoming
Type or print plainly in ink and sign in ink.
Oil and Gas Lease, or Geothermal Lease
2. This assignment conveys the following interest:
Land Description
Additional space on page 2, if needed. Do not submit documents or agreements
other than this foram; such documents or agreements shall only be referenced herein.
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 tb this lease.
Assignment approved for above described lands;
JAM 0 1
Assignment approved effective
0
By
La,
(Continued on page 2)
Bureau of Land Management (BLM)
PART A: ASSIGNMENT
FORM APPROVED
OMB NO. 1004-0034
Expires: April 30, 2009
Lease Serial No.
WYW 174337
Lease Effective Date
(Anniversary Date)
01/01/2008
New Serial No.
0060'70
Overriding Royalty, payment out of production or other similar interests
or payments
Percent of Interest
Owned
b
100.00%
Conveyed
c
100.00%
Retained
d
0.00%
Reserved
e
0.00%
RECEIVED 2/8/2010 at 1:06 P
RECEIVING 952
BOOK: 742 PAGE: 70
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMM
Percent of
Overriding Royalty
Similar Interests
Previously
reserved
or conveyed
f
0.00%
Assignment approved for attached land description
Assignment approved for land description indicated on reverse
of this form
(Title)
ERER, WY
JAN 1 b 2010
(Date)
Part A (Continued): ADDITIONAL SPACE for, s and addresses of additional assignees in Item No.1, if d, or for Land Description in Item No. 2, if needed.
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
DALLAS
1¢
Name of Assignor as shown on current le
(City)
(Continued on page 3)
PART B CERTIFICATION AND REQUEST FOR APPROVAL
day of 3) `C_ 20 09
MATADOR RESOURCES COMPANY
Assignor A L•
diV" V Si n ature
David E. Lancaster, -cuti .'ce -Pres. CFO
(Signature)
5400 LBJ FREEWAY, ONE LINCOLN CENTRE, SUITE 1500
(Assignor's Address)
TX 75240 1017
(State) (Zip Code)
Executed this
(Please type or p
Assignee
00 O` i
1 4 day of e_C-
20 09
(Si: ature
David E. Lancaster, Executive Vice -Pres. CFO
MRC ROCKIES COMPANY
5400 LBJ Freeway, One Lincoln Centre Ste 1500
Dallas, TX 75240 -1017
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 any matter within its jurisdiction.
(Form 3000 -3, page 2)
STATE OF TEXAS
COUNTY OF DALLAS
ACKNOWLEDGMENT
e000 72
The foregoing instrument was acknowledged before me, a Notary Public in and for the State of
Texas, by David E. Lancaster, Executive Vice President and CFO of MRC Rockies Company, on behalf
of said company, on this 14 day of December, 2009.
Notary Public,
State of Teat
Comm. Eq. 084011,
My Commission Expires: 08 -20 -2011
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