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Home My WebLink About961192000463 Form 4 -1158 Ninth Edition (August 1961) BUREAU OF LA OFFER TO LEASE AND LEASE FOR OIL AND GAS (Sec. 17 Noncompetitive Public Domain Lease) ,ersigned hereby offers to lease all or any of the lands described in item 2 that are available for lease, pursuant 'nil 1u11 the terns and provisions of the act of February 25, 1920 (41 Stat. 437, 30 U. S. C. sec. 181), as amended, hereinafter referred to the act, and to all reasonable regulations of the Secretary of the Interior now or hereafter in force, when not inconsistent with any express and specific provisions herein, which are made :a part hereof. Mr. Mrs. 1. Miss L 2. Land requested: State 3. Land included in lease: State RECEIVED 9/28/2011 at 3:42 PM RECEIVING 961192 BOOK: 773 PAGE: 463 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY (Offeror does not fill in this block) Flfr -Hive, date of lease UNITED STATES DEPARTMENT OF THE INTERIti,r BUREAU OF LAND MANAGEMENT Mrs. Ruth R. Ellbogen (First Name; Middle Initial, Last Namel P. 0. Box 1581 (Number and Street) Casper Wyoming 82602 City and State) Parcel #671 Wyoming County 4. Amount remitted: Filing fee $10, Rental -Total RPM to be R.#fdl6 4►� m t�Qm ara Ive espy Of t g PffiQ14 r e()Ora 0M file August 1, 1964 1 J (Lessee signature) Form approved. Budget Bureau, No. 42- R990.4. Office WXOMING Serial No. Offeror duly executed this instrument this day of 19 V County T. R. Meridian Total Area Acres Lincoln T. 21N R. 112W 6th p Meridian Sec. 2: Lots 5, 6, 7, 8, S N Sec. 4: Lots 5, 6, 7, 8, 52121 SS Sec. 6: Lots 8 14, S VE SE- l ,�it]V E SW 1 SE i Sec. 8 N2E4f SE,;P1E T. 22 N., R. 112 W., 6th -'P.M. Sec. 3 SW- S2 Total Area 2361.39 Acres Rental retained $13.81 00 5. Undersigned certifies as follows: (a) Offeror is a citizen of the United States. Native born Naturalized Corporation or other legal entity (specify what kind): (b) Offeror's interests, direct and indirect, do not exceed 200,000 acres in oil and gas options or 246,080 chargeable•acres in options, offers to lease and leases in the same State, or 300,000 chargeable acres in leases, offers to lease and options in each leas- ing district in Alaska. (c) Offeror accepts as a part of this lease, to the extent applicable, the stipulations provided for in 43 CFR 191.6. (d) Offeror is 21 years of age or over (or if &corporation or other legal entity, is duly qualified as shown by state- ments made or referred to herein). (e) Offeror has described all surveyed lands by legal subdivisions, all lands covered by pro- tracted surveys by appropriate subdivisions thereof, or all unsurveyed lands not covered by protracted surveys by metes and bounds, and further states that there are no settlers on unsurveyed lands described herein. 6. Offeror is is not the sole party in interest in this offer and lease, if issued. (If not the sole party in interest, statements should be filed as prescribed in Item 6 of the Special Instructions.) 7. Offeror's signature to this offer shall also constitute offeror's signature to, and acceptance of, this lease and any amendment thereto that may cover any land described in this offer open to lease application at the time the offer was filed but omitted from this leas, for any reason, or signature to, or acceptance of, any separate lease for such land. The offeror further agrees that (a) this offer cannot be withdrawn, either in whole or in part, unless the withdrawal is received by the land office before this lease, an amend-' ment to this lease, or a separate lease, whichever covers the land described in the withdrawal, has been signed in behalf of the United States, and (b) this offer and lease shall apply only to lands not within a known geologic structure of a producing oil or gas field -at the time the offer is filed. 8. If this lease form does not contain all of the terms and conditions of the lease form in effect at the date of filing, the offeror further agrees to be bound by the terms and conditions contained in that form. 9. It is hereby certified that the statements made herein are complete and correct to the best of offeror's knowledge and belief and are made in good faith. (Attorneyin (act) msc for he lands described in item 3 above is hereby issued, subject to the provisions of the offer and on the reverse side hereof. THE UNITED STATES O,,ssF�� AMERICA (Signing micer) David B. Morgan j y_ (Title) Chief, Mineral Leasing Sec-.on u F?• 2 l.Ia ;i P: REJECTED AND RETURNED TO THE OFFEROR AND WILL AFFORD THE a2'rEtOR f IS NOT PROPERLY FILLED IN AND EXECUTED OR IF IT IS NOT ACCOMPANIED BY THE REQUIRED DOCUMENTS PA''.'", SEE ITEM 9 OF GENERAL INSTRUCTIONS ;hakes it a crime for any person knowingly and willfully sake to any Department or agency of the United ,e.. 9r fraudulent statements or representations as to any matter withinits jurisdiction.. ram! uecu provided that the copies are exact reproductions on one sheet of both sides of this official form, in accordance with the provisions or 3 CFR /92.9.09.