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HomeMy WebLinkAbout9533883. Specify interest or percent of operating rights being conveyed to assignee 12.5% 4. Specify interest or percent of operating rights being retained by assignor None 5, Specify overriding royalty interest being reserved by assignor None 6. Specify overriding royalty previously reserved or conveyed, if any 5% of 8 /tittis, 27 of S% of R /Rths ti /SthE. 7 5% of 8 /8th Form 3106 -14 (September 1952) 1. Assignee's Name GENERAL HYDROCARBONS 1982X OIL AND GAS PROGRAM Address (include zip code) P. 0. Box 31515, Billings, Montana 59107 -1515 Township 26 North, Range 111 West, 6th P.M. Section 5: Section 6: Section 8: Containing 479.67 acres, more or less, Lincoln County, Wyoming RECEIVED 5/12/2010 at 10:22 AM RECEIVING 953388 BOOK: 747 PAGE: 43 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY Executed this Assignment approved effective UNITED STATES DEPARTMENT OF THE IN"fEiv1O14 1 BUREAU OF LAND MANAQjj l' YIft I Lot 4, SIINW SW4 Lot 1, SEINE 4, E ZSE 4 SE 4 1[1 PART I By f T E1; TRANSFER, ASSIGNMENT, OR S p E`'7 N1 9 30 OF OPERATING RIGHTS IN OIL ANb AS' LEASE Lease Serial No. W- 728 45. The undersigned, as owner of 12.5 percent of operating rights in the above- designated oil and gas .lease, hereby transfers, assigns, and /or subleases to the assignee shown above, the operating rights in such lease as specified below. 2. Describe the lands affected by this transfer, assignment, and /or sublease (43 CFR 3101.2 -3 or 3101.1 -4) TriCounty (WY -467) FORM APPROVED OMB NO. 1004 -0034 Expires: August 31, 1985 ,ease effective date October 1, 1981 7. If any payments out of production have previously been created out of this interest, or if any such payments are being reserved under this transfer, assignment, or sublease, attach statement giving full details as to amount, method of payment, and other pertinent terms as provided under 43 CFR 3106. It is agreed that the obligation to pay any overriding royalties or payments out of production of oil created herein, which, when added to overriding royalties or payments out of production previously created and to the royalty payable to the United States, aggregate in excess of 17 1/2 percent, shall be suspended when the average production of oil per well per day averaged on the monthly basis is 15 barrels or less. I CERTIFY That the statements made herein are true, complete, and correct to the best of my knowledge and belief and are made in good faith. ,19 GENERAL HYDROCARBONS, INC. P. 0. Box 31515 Tee UNITES) STATES OF AMERICA (Assignor's Address) tAssignor's Signature) Wayne H. Chestnut, President .6T-' T: Billings, Montana 59107-1515 (lo _13_3 Heuveren, Assistant Secretary (City) (State) (Zip Code) 'Title 18 Section 1001, makes it a crime for anv person knowingly and willfully to maiie to any department or agency of the States any faise, fictitious, fraudulent statements or representations as to any matter within its jurisdiction. (Title) (Authorized Officer) (Date) NOTE: This form may be reproduced provided tba% copies are exact reproductions on one sheet of both sides of this o /ic:al form in ac<o arse with provisions of 43 CFR 3106. CER` i- 'IED to be atrue and compareV 'copy of the official records'ori file s CCO A)43 AP 1 4 2019 BUREAU OF LAte MANAGEMENT A. ASSIGNEE CERTIFIES THAT the assignee and all other parties in interest (as defined in 43 CFR 3100.0 -5(b)) in this as- signment are: 1. Citizens of the United States or qualified alien stockholders in a domestic corporation; association of the United States; or any State or Territory thereof; or municipalities. 2. Of the age of majority in the State where the lands to be assigned are located. 3. In compliance with the acreage limitation set forth in 43 CFR 3101.1 -5 and 3101.2 -4. B. ASSIGNEE AGREES That, upon approval of this transfer of operating rights and /or operating agreement (sublease) by the authorized officer of the Bureau of Land Management, he will be bound by the terms and conditions of the lease described herein as to the interests covered by this assignment, including, but not limited to, the obligation to conduct all operations on the leasehold in accordance with the terms and conditions of the lease, to condition all wells for proper abandonment;to restore the leased lands upon completion of any drilling operations as prescribed in the lease, and to furnish and maintain such bond as may be required by the lessor pursuant to the regulations (43 CFR 3104.2). C. IT Is HEREBY CERTIFIED That the statements made herein are true, complete, and correct to the best of undersigned's knowledge and belief and are made in good faith. Executed this day of °..c. —ems Wayne H. Chestz{ut ATTEST: L, 14 (��Ltt� /ti �JoMn B. Van Heuvelen, Assistant Secretary ASSIGNEE'S APPLICATION FOR APPROVAL OF TRANSFER OF OPERATING RIGHTS ANDinR OPERATING AGREEMENT (SUBLEASE) rifle 18 U.S.C., Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency States any false, fictitious, orfraudulent statements or representations as to any matter within its jurisdiction. 1. USE OF FORM Use only for assignment of operating rights (including working interests) in oil and gas leases. If transfer of operating rights is accompanied by an operating agreement, a single copy of such agreement must be submitted with the assignment. If more than one transfer of operating rights is made out of a lease, a separate instrument of transfer is required for each assignment. A separate instrument of assign- ment shall be used for each lease out of which an assignment is made. FILING AND NUMBER OF COPIES File three (3) completed PART II GENERAL HYDROCARBONS 1982X OIL AND GAS ,19 •PROGRAM by General Hydrocarbons, Inc., Managing General Partner INSTRUCTIONS NOTICE (Assignee's Address) P. 0. Box 31515 Billings, Montana 59107 -1515 The Privacy Act of 1974 and the regulation in 43 CFR 2.48(8) provide that you be furnished the following information in connection with information required by this assignment and request for approval. AUTHORITY: 30 U.S.C. et. seq. PRINCIPAL PURPOSE Tne information is to be used to process the assignment and request for approval. ROUTINE USES: (1) The adjudication of the assignee's rights to the land or resources. (2) Documentation forpublic information in support of nota- tions made on land status records for the management, disposal, and use of public lands and resources. (3) Transfer to appropriate Federal agencies when concur- rence is required prior to granting a right in public lands or resources. (4)(5) Information from the record and /or the record will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions. EFFECT OF NOT PROVIDING INFORMATION If all the in- formation is not provided, the assignment may be rejected. The Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.) requires us to inform you that: This information is being collected pursuant to the law (43 CFR 3106- 3(c)). This information will be used to create a record of lease assignment. Response to this request is required to obtain a benefit. (City) (State) (Zip Code) of the United and manually signed copies in the appropriate BEM office. A $25.00 nonrefundable filing fee must accompany this assignment. File assignment within ninety (90) days after date of final execution. 3. EFFECTIVE DATE OF ASSIGNMENT The assignment, if approved, takes effect on the first day of the month following the date of filing of all required papers. If an operator's bond is required, it must be furnished prior to approval of the assignment. 0'0'3044 STATE OF MONTANA COUNTY OF YELLOWSTONE s s. BEFORE ME, the undersigned authority, in and for said county and state, on this day personally appeared WAYNE H. CHESTNUT, known to me to be the person and officer whose name is subscribed to the foregoing instrument and acknowledged to me that the same was the act of the said General Hydro- carbons, Inc., a corporation, and that he executed the same as the act of such corporation for the purposes and consideration therein expressed, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS day of 1984. I tary Public `JO Ann uukart My Commission Expires STATE OF MONTANA ss. ,:NOTARY PUBLIC Jo Ann Dukart GENERAL HYDROCARBONS, INC. BURS „l hiy My commission expires OF :r,,_ 000045 COUNTY OF YELLOWSTONE On this day of 19 before me, a Notary Public, personally appeared WAYNE H. CHESTNUT, to me personally known, who, being by me duly sworn, did acknowledge before me under oath that he is the President of General Hydrocarbons, Inc., the corporation that is the general partner of the partnership named in the foregoing instrument, that he executed said instrument on behalf of said corporation by the authority of its Board of Directors, and that said instrument is the free act and deed of said corporation as said general partner. CE R11F ED to be a true and comparative copy of the official Tecords,op file AP 1 4 2010 A.