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Home My WebLink About958048Land Description Percent of Interest Percent of Overriding Royalty Similar Interests 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 Convey y c Retained d Reserved e Previously reserved or conveyed f c l T-- -L N `J f_ sue tip2SE4 RECEIVED 2/11/2011 at 12:04 PM RECEIVING 958048 BOOK: 762 PAGE: 368 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY tc e.° a of e E` 1 Lf wl e and corn official reccrds nit LEI l rarativc ^cra on file ?O11 .AGEIViE FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE ry Form 300C (January 2010) By 1. UNITED ST A'_� DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL ICES Mineral Leasing Act of 1920 (30 U.S.C. 1E Act for Acquired Lands of 1947 (30 U.S.0 Geothermal Steam Act of 1970 (30 U.S.C. 1001 -1025) '.Department of the Interior Appropriations Act, Fiscal Year 6508) Type or print plainly in ink and sign in ink. ki(c)t \#L``lC. t. 1 PART A: ASSIGNMENT As si ee C' •C't F61 ..lt �1✓. A\ rRA_ :3 TCC Street I z City, State code G; �i f S 1 �v C >.S C l` K 3 C i)Iit la. Assignor *If more than one assignee, check here L j and list the name(s) and address(es) of all addtional assignees onpage 2 of this form or on a separate attached sheet ofpaper. This record title assignment is for: (Check one) Oil and Gas Lease, or Geothermal Lease Interest conveyed (Check one or both, as appropriate) 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; Assignment approved effective Assignment approved for land description indicated on reverse of this form (Continued on page 2) Bureau of Land Management (BLM) rUicrvr APPROVED OMB NO. 1004 -0034 Expires: July 31, 2012 Lease Serial No. Lease )affective Date (Anniversary Date) New Serial No. 000368 Record Title, M Overriding Royalty, payment out of production or other similar interests or payments Assignment approved for attached land description (Title) (Date) NT Part A (Continued): ADDITIONAL SPACE fo, .,ames and addresses of dditional assignees in Item No. 1, ii .__aded, or for Land Description in Item No, 2, if needed. DNA c°J t'\ t7Y\ f COY q` PART B CERTIFICATION AND REQUEST FOR APPROVAL 000369 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 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,,.. 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 1 1 day of J14 v NK 9 20 4 E Executed this i 1 day of /W O\ t 20 Name of Assi as shown on current lease 6 l aQ P( i r e. J �(Please or print) Assignor r::) Assignee or Attorney-in fact (Si ature) B ci 5" 3 z,; en t OK0 (Assignor's Address) (City) (State) (Zip Code) (Continued on page 3) ature) or Attorney -in -fact (Signature) Title 18 U.S.C. Seel 001 makes it a crime for any person knowingly and willfully to makc to any Department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. to be a tr Wand comparative copy of th official records on file RUREAI OF LAND M 6 r4 AGEMENT (Form 3000 -3, page 2) CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT State of California County of t,' k_ On A Dale personally appeared LIZA S. QUESADA Commission 1894953 Notary Public California i Contra Costa County MyComm. Expires Aug 6, 2014 Place Notary Seal Above Title or Type of Document: Document Date: before me, Capacity(ies) Claimed by Signer(s) Signer's Name: Individual Corporate Officer Title(s): Partner Limited' General Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: 3 2007 National Notary Association 9350 De Solo Ave.. P.Z4it BUR Top of thumb here i 00:370 144\ t vyfitt•_. Here Insert Name and T e of the Officer I LAND si P I who proved to me on the basis of satisfactory evidence to be the person( whose name( &re subscribed to the within instrument and acknowledged to me that i he /trey executed the same in hi er /their authorized capacity(ige)., and that by h.s -.er/ firs natureA on the instrument the person (.'or the entity upon behalf of which the person( acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m NAGEMENT Namet9) of Signer(, and and o ial s Signa re Signer Is Representing: of Notary P Signature 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 a Number of Pages: Signer(s) Other Than Named Above: Signer's Name: Individual '0 Corporate Officer Title(s): O Partner Limited 0 General Attorney in Fact Trustee Guardian or Conservator Other: Top of Ihumb here t�' i nI C, V u "`;%4 .:%C'%•�.."J.:`.i�: �_."_v '�C:`�C:`..:.- :,:��.':i`..v:: i.: J�; ree.b bryftwo www.NalionalNotar org Ilem 4'5907 Reorder:Call Toll -Free 1.80b- 876 -6627