HomeMy WebLinkAbout873400Form 3000-3a UNITED STATES
(January 1996) DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A
LEASE FOR 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)
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)
FORM APPROVED
OMB NO. 1004-0034
Expires: September 30, 1998
Lease Serial No.
W-33552
I ype or print piaimy in ink and sign In Ink -
1. Transferee (Sublessee) * PART A: TRANSFER Street Teckla Oil Co., LL C
4791 E. Stallion Lane
City, State, ZIP Code Inverness, Florida 34452-9083
*If more than one transferee, check here ❑ and list the name(s) and address(es) of all additional transferees on the reverse of this form or on a
separate attached sheet of paper.
x
This transfer is for: (Check one) E)j Oil and Gas Lease, or ❑ Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) ❑ Operating Rights (sublease) EX Overriding Royalty, payment out of production or other
similar interests or payments
2. This transfer (sublease) conveys the following interest:
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
this form; such documents or a
reements shall onl
be r
i
d h
f
or Similar Interests
g
e
ere
n.
y
erence
Reserved
Previously
reserved
or conveyed
a
b
c
d
e
f
state of Wyoming, County of Lincoln
100%
0%
T. 25 N., R. 112 W., 6th Prin. Mer.
ORR
ORR
Sec. 1: Lots 1, 2, 3, 4, WLE2, W-z
2: E
REC
DYED
L lI
COf._N CO
UNTY CL
ERK
.ontaining a total of 957.72 acres, m.o
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FUR BLM USE ONLY-DO NOT WRITE BELOW THIS LINE
THE UNITED STATES OF AMERICA
This transfer is approved solely for administrative purposes. Approval does not warrant that either party to this transfer holds legal or equitable
title to this lease.
❑ Transfer approved effective
M
Part A (Continuer,.""'T.um37oNAL SPACE for Names and addresses of additional transferees in Item No. 1, if needed, or for Land Description in Item No. 2 if needed.
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0873400
809
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. The transferor certifies as owner of an interest in the above designated lease that he/she hereby transfers to the above transferee(s) the rights specified above.
2. Transferee certifies as follows: (a) Transferee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the ;aws
of the United States or of any State or territory thereof. For the transfer of NPR-A leases, transferee 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; Transferee is not considered a minor under the laws of the State
in which the lands covered by this transfer are located; (c) Transferee'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 )eases (of which up to 200,000 acres may he 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) Ali parties holding an interest in the transfer are otbenvisc in compliance with the regulat ons (43 CFR Group
3100 or 3200) and the authorizing Acts; (e) Transferee is in compliancewith reclamation requirements for all Federal oil and gas lease holdings as required by see. I7(g)
of the Mineral Leasing Act: and (f) Transferee is not in violation of sec. 41 of the Mineral Leasing Act.
3. Transferee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein.
Applicable terms and conditions include, but are not limited to, an 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 operations as described in the lease, and to furnish and maintain
such bond as may be required by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206.
For geothermal transfers, an overriding royalty may not be less than one-fourth ('A) 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 transfer is added to all previously created overriding royalties (43 CFR 3241).
s 1 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.
02
Executed this day 15 day ofa_ t9
Executed this
NameofTransferor ClaarlpS L Strange 'T`rust established May 6, 1974
Pl or riot
Transferor Transferee
or T e c k l a Oil Co., L L C
(Si re)
Charles E. Strange, Trustee ®yut, r name)
(Sipature) (Sign re)
8816 Canyon Springs Drive Monica Haufler, Managing Member
(Trankroes Address)
Las Vegas Nevada 89117
(City) (state) (zip code)
BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 3u mmutes per response including the time for 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), Denver Federal Center, Building 40, P.O. Box 25047, Denver„Ct7 80225 047 and the Office of Management and
Budget, Paperwork Reduction Project (1004-0034), Washington, D.C. 20503. "e uadente~
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.
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087 340
R10
ACKNOWLEDGMENT
STATE OF FLORIDA)
) ss
COUNTY OF CITRUS)
Personally appeared before me the undersigned authority, the within named,,,,,;;,,,f
Monica Haufler known to me to be the person whose name us subscribed to the''",~t3%i
foregoing instrument and acknowledged before me that she executed the sawir•i'e'"''•
purposes and consideration therein expressed, in the capacity therein state;' 'Q7
GIV N UNDER (WITNESS) MY HAND AND SEAL OF OFFICE THIS
.,y
DAY OF
2001.
t/<llgltlillt,,,
My commission expires:
RICHHEIMER
FRANCES J
.
MY COMMISSION M CC 744475
EXPIRES: June 9, 2002
, Notary Public
Bonded Thnr Notary Public underwriter-
Acknowledged before me this
r day of ~.L f
T
Notaryc Public In and for e
County of CIcAek .gtatca of Nevada
ELIZABETH L. NEMEC
Notary Public - Nevada
N.,
. 00-64818-1
My aPPt- onP. Aug. 23, 2004
For the tate of Florida
Residing in Citrus County, Florida
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