HomeMy WebLinkAbout961203(October 1992)
Type or print plainly in ink and sign in ink.
PART A: TRANSFER
1. Transferee (Sublessee)* CROWN OIL GAS COMPANY, INC.
Street 152 Calpet Road, P.O. Box 519
Big Piney, WY 83113
*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-
separate attached sheet of paper.
This transfer is for: (Check one) L_J Oil and Gas Lease, or Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) Operating Rights (sublease) El Overriding Royalty, payment out of production or other
similar interests or payments
2. This transfer (sublease) conveys the following interest:
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.
Township 24 North. Range 112 West. 6th P.M,
Section 1: Lots 3 (31.18), Lot 4 32.00), SE /4NW /4
Insofar and only insofar as leased lands contribute to the drillsite spacing unit
limited to the Reservoir 10 -1 wellbore and the production therefrom; located
in the SENW Section 1- 24N -112W, Lincoln County, Wyoming
By
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.
to be a true an comparative copy
of the official records on file
l�,�lllli it
BUREAU OF LANu
UfHN
X Transfer approved effective
LL
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)
TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
Ala lug)
Authorized cer
V I NA 1 A l LJ
DEPARTN 1' OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
a
FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE
THE UNITED STATES OF AMERICA
MAR 01 2000
Percent of Interest
Owned
Conveyed
c
75.00000% 75.00000%
Retained
-0
Reserved
RECEIVED 9/28/2011 at 4:14 PM
RECEIVING 961203
BOOK: 773 PAGE: 494
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
LAND LAW EXAMINER
(Title)
FORM APPROVED
OMB NO. 1004 -0034
Expires: July 31, 1995
Lease Serial No.
WYW -85245 0 0 0 4 9 4
OR
(Date)
49 -0647
Percent of
Overriding Royalty
or Similar Interests
Previously
reserved
or conveyed
f
-0- OF-RECORD
cD
t)
1
s. A L
MA.?, 1 5 ZOOft
1
Part `A. (Continued): ADDITIONAL SPACE for Names and addresses of additional transferees in item No. 1, if needed, or for Land Description in Item No. 2 if needed.
Attorney -in- fact;.!
Effective June 1, 1999
Nion?of Transferor F.`?�$OT. L i& CORPo
Please type or print
Ctrafcror 1.1!",,
b" 7dh Muire
44
br�
Transferee
Attomey -in -fact
t! r c,: 4 u i`.cif .t 7 S y.
:r,clrr 44 ,0 1w 1 g r r Q i!q:FART 3 TCEIRT CATIONAND_ :REQUESTFOR:APPROVAL
vOitittifik is Iownar of'intiatemlt in the:I ase te/she hereby trap fers. the above;transferee(s) the rights specified above.
I I
2. certifies as follows. (a) Transferee is a citizen of the United Sates; an association °f inch citizens; a municipality; or a corporation organized under the laws
of the United States or. of any State or territory thereof. For the transfer of NPR A leases, transferee' is *citizen, national, or resident of the United States or
1 9?assoastionsof sooh.c ijeas, nati aii1s,tesid ent idieliSOr privatc, public or municipal corporations; (b) Transferee is not considered a minor under the laws of the State
in which the lands covered by this transfer *located; (c) Transferee's chargeable interests, direct and indirect, in each public domain and acquitediands separately in I',
r' i'!6'saline.State,.do, r'gt< Z4 6;t$i0 tiers n'oil and gas leases (of which up to 200,000 acres may bew oii andgai o, 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) All parties holding an interest in the nensaferare otherwisd in compliarree-with the regulations (43 CFR Group
s
T isferee isin compliance •withtaelernadonxgmtememts for all;Federni-oil- end gas -lease boldings-es-required by sec.', 17(g)-
of the Mineral Leasing Act,. and (f) Transferee is not in violation of sec. 41 of the Mineral Leasing Act. `t
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 opaatrons.on:tbe leasehold in accordance with the term's and conditions of ''1
the lease, to condition.ali wells for
a bandonmeut'to restore the leased:lamds upon completion of any as described in the lease, and to fuiuis6 e maintain
4'' '7!.Cj' -7'6- 7 !I: .i. II:s. "'iY iti c iV'''icieliieiei" kilitineiefatatliaaotone perceoto the vidueCif output, nar_greater than 50pereint of tbe rateo
i
yalty!.
I certify that the statements made herein by me ere true, complete, and correct to the best of niy knowledge and belief and are made in good faith:;
1?at2@ated this ,l c Still o� ts;;r:d ,43ctob ,,19 .9912;; rpxec tedthis r of!s:< g/1! 2I
CROWN 'IL
:Davi3-W. Nelier,Pres'dent'
ASiyANY, INC.
(Signature)
PI.
99
(Transfc.u, s Address) jousjon.' TX 77077=14344
(City) (State) (Zap Code)
n BVit0EiviHOURS:STATLEIYtENT I!,
0495
Public reporting burden for:this form is estimated to average 30 minutes per 'response, including the time for reviewing instructions, gathering and maintaining data, and
completing and 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
I ri' 1, C z.- Z t I r r t. c t` C I
Management,,(Alteert i ararlcd icW i 73)ra$hndi7 net 1 W' LMashtngton,1Dt. 20240, and the OtfieebkMVleinagement and Budget, Paperwork!
Reduction Project.()13t?0:R31,0 ?G,17aliking 531C t L2 :is 21.1 x II I!I
Title 18 U.S.C.,ISec. 1001 makes it a crime for any person knowingly and willfully to make any Department or agency of the.Untt&1 Statesany false fictitiouslof
statements or representations as to any matter witt,4.;.
y: landitnctnerson /wyw- 85245optROWN
*U.S. GPO: 1992 774 017/67023