HomeMy WebLinkAbout95341350.1183 -00
Form
(March '4091
1. Assignee*
Street
City, State, ZIP Code
-5 M 0 on ADP
•a .a raw t
ASSIGNMENT OF RECORD TITLE INTEREST IN A
v, L M n E ASE FOR OIL AND GAS OR GEOTHERMAL .RESOURCES
Cyr_.
2. This assignment conveys the following interest:
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351 -359)
Geothermal Steam Act of 1970 (30 U.S.C. 1001 -1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
PART A: ASSIGNMENT
Celsius Energy Company
P.O. •Box 11070
Salt Lake City, Utah 84147
*If more than one assignee, check here 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) 3 Oil and Gas Lease, or Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) a Record Title, Overriding Royalty, payment out of production or other similar
interests or payments
Land Description
Additional space on reverse, if needed. Do not submit documents or agreements other than
this form; such documents or agreements shall only be referenced herein.
a
Township 19 North, Range 113 West, 6th P.M.
Section 4: Lots 1, 2, 4, S /2NE /4, SE /4
Section 6: Lots 1, 2, 3, 4, 5, 6, 7, S /2NE /4
SE /4NW /4, E /2SW /4
containing 809.60 acres, more or less
Lincoln County, Wyoming
Township 19 North, Range 113 West, 6th P.M.
Section 26: All
containing 640.00 acres, more or less
Lincoln County, Wyoming
RECEIVED 5/12/2010 at 10:42 AM
RECEIVING 953413
BOOK: 747 PAGE: 118
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
Assignment approved for above described lands;
Assignment approved effective
By
(Authorized Officer) i
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
Type or print plainly in ink and sign in ink.
(Title)
9118
FORM APPROVED
OMB NO. 1004 -0034
Expires: July 31, 1992
Lease Serial No.
WYW 113131
Lease Effective Date
(Anniversary Date)
October 1, 1988
New Serial No.
Percent of Interest
Owned
b
50%
100%
Conveyed
c
25%
Retained
d
25%
Reserved
e
50% 50% 0
CE TIFIFCC
to a tru
Of the
d comparat
I records o
Assignment approved for attached land description
Assignment approved for land description indicated
of this form.
Percent of
Overriding Royalty
or Similar Interests
Previously
reserved
or conveyed
f
0
(Date)
5%
5%
ve copy
file
0
on reverse
GEMENT
ORk!NAL
LY —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.
jijN 19"„
'art 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.
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. 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.
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 te States or ociati n such cia zens. nationals` resident aliens or private, n public or municipal s
un cipalscorporations, (b)tAssitgneetis not considered a minor under the
laws uired lads se arat t l hi the State, do not exce d 080 a oil and s gass leases (of up to 200,000 cacresma indirect, the lnds covered by this assigment arc ybe "in oil and u ga t s options) or
acq p
300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in opti�n options, if f atties holding gas lease
in the are
in accordance
Assignee old
with the Mineral Leasing Act of 1920, or 51.200 acres in any one State if this is a geothermal lease; (d) p is in compliance ne with reclamation
otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e)
requirements for all Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral Leasing Act; and (t) 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 o the United States when this s assignment is added less
io than
previously created overriding percent
oyalt output,
(43 CFR 3241) tit nor greater than 50 percent of the rate of
royalty due t
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.
26th day of 19 93
day of March
19 93 Executed this
Executed this 16th
Celsius Energ Company
n er•y Partners Nominee Company
Name of Assignor as shown on current leas
de t o (Signature)
$lea t y or print
Assignor 6 Pres
{nature) st i Vice Preside pax
A TTEST:
or Bruce E. John �f xx ct
Atrorney (Signature)
Leon R. Bailej J Assistant Secretary ATTEST: Assistant
1777 South Harrison Street, P -1
(Assignor's Address)
Denver CO 80210
(City) (State) (Zip Code)
Secretary
000119
Public reporting reviewing gen e this form estimaestimated ave 30
minutes the burden response, timate or estimate other aspect of this form to Departtmenttofthe Interior, maintaining eau data,
and of
and compleple and he for Direct comments regarding
Land Management, (Alternate) Bureau Clearance e Officer, (WO -771), 1849 C Street, N.W.. Washington. D.C. 20240, 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 any matter within its jurisdiction.
'U.S. Government Printing Office: 1991 573 016/26062