HomeMy WebLinkAbout958047Land Description
Percent of Interest
Percent of
Overridin Royalty
S imilarnterests
Additional space on page 2, if needed. Do not submit documents or agreements
other than this form; such documents or agreements shall only be referenced herein.
a
Owned
b
Conveyed
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FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINT`
Form 3000 -3
(January 2010)
2. This assignment conveys the following interest:
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; El Assignment approved for attached land description
Assignment approved effective
By
1.
t7lh t r NN'1 t r, PART A: ASSIGNMENT
Assignee G i I C. i 1 L Ili 1`o ITC S IT L
Street X'
Zip Code L X' 31 C c (-16` S �f l N1 C a (0.V Assignor C, 3 1 L. L 1. K
�A CticC
*If more than one assignee, check here and list the name(s) and address(es) of all addtional assignees onpage 2 of this form or on a separate attached
sheet of paper.
This record title assignment is for: (Check one) Oil and Gas Lease, or Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) Record Title, J" Overriding Royalty, payment out of production or other similar interests
or payments
(Continued on page 2)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
ASSIGNMENT OF RECORD TITLE INTEREST IN A
c.‘Q EASE 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.0 351 359)
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)
Bureau of Land Management (BLM)
Type or print plainly in ink and sign in ink.
RECEIVED 2/11/2011 at 12:03 PM
RECEIVING 958047
BOOK: 762 PAGE: 365
JEANNE WAGNER
New Serial No.
Assignment approved for land description indicated on reverse
of this form
FORM APPROVED
OMB NO. 1004 -0034
Expires: July 31, 2012
Lease Serial No.
\,(V 4 1714
Lease Effective Date
(Anniversary Date)
00365
(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.
6 t fJ
C.
PART B CERTIFICATION AND REQUEST FOR APPROVAL
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, m 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 m 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
heron.
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 2;;
royalty due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241).
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.
Executed this day of Jr `I 20 4
Name of Assign c)4 as shown on current lease
(Please type print)
Assignor Assignee
ignature) or
or 1
Attorney-in-fact
L.> LA.-C 3 (srgc., 65 fQ0 Po)
(Assignor's Address)
(Continued on page 3)
GI D1
Executed this t day of J P t\- 1 20
to btl a e ancomparative copy
of t e otfici ecords on -file
BU' 0 LAND AGEMENT
(Signature)
000366
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)
i 'l(L t k
State of California
County of a
On r C be me,
Date
personally appeared
z
z
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Signer Is Representing:
LIZA S. QUESADA
Commission 1894953
Notary Public California
Contra Costa County
My Comm, Expires Aug 6, 2014
Place Notary Seal Above
z
D
Individual
Corporate Officer Title(s):
Partner Limited General
Attorney in Fact
Trustee
Guardian or Conservator
Other:
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C.�: J 1'.`- _J..'tiC. _iC'.'_/.:`w J.:`- .4✓
2007 National Noary Association 9350 De Solo Ave., P.C. eox 24'02
BUR
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WITNESS m
Signature
wet, 1-
ittaPIe br
1
OF LAND AGFMFMIT
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
A�. ^C
000367
ie Insert Name and Title of Ibe officer
Name(f) of Signer(?)
who proved to me on the basis of satisfactory evidence to
be the person( whose name( ig -re subscribed to the
within instrument and acknowledged to me that
h I� tlry executed the same in histrpeir authorized
capacity(0)-, and that by tail er /t signature(,) on the
instrument the person(.>3,1, or the entity upon behalf of
which the persona\ acted, executed the instrument.
1 certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct
and and
Ti
eat
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: rnSS`c
Document Date: U Number of Pages:
Signer(s) Other Than Named Above:
J d- L'n Lt-c>4.4
Signer's Name:
Individual
Corporate Officer Title(s):
Partner Limited General
Attorney in Fact
Trustee
Guardian or Conservator
Other:
8 t°
Signer is Representing:
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