HomeMy WebLinkAbout963060Land Description
Percent of Interest
Percent of
Ovemdi In Royally
Similar Interests
Additional space on page 2, if needed. Do not submit documents or agreements
other than this forth; such documents or agreements shall only be referenced herein.
a
Owned
b
Conveyed
c
Retained
d
Reserved
e
Previously
reserved
or conveyed
f
Township 26 North, Range 113 West, 6th P.M., Wyoming
Section 3: Lots 6, 7, 10, 11, NW1 /4 SE1 /4
Section 10: N1/2 NW1/4, SW1. /4 NW1/4
RECEIVED 2/3/2012 at 11:39 AM
RECEIVING 963060
BOOK: 780 PAGE: 722
JEANNE WAGNER
.INCOLN COUNTY CLERK, KEMMERER, WY
See
Exhibit
"A"
See
Exhibit "A"
of record
Form 3000 -3
(May 2006)
Ali
By
1. Assignee*
Street
City, State, Zip Code
UNITED STATES
DEPARTMENT OF THE INTERIOR
9. 00 BUREAU OF LAND MANAGEMENT
ASSIGNMENT OF RECORD TITLE INTEREST 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.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)
See Exhibit "A"
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
la. Assignor See Exhibit "A"
FORM APPROVED
OMB NO. 1004 0034
Expires: April 30, 2009
Lease Serial No.
WYE 07798A
Lease Effective Date
(Anniversary Date)
New Serial No.
*If more than one assignee, check here Q and list the name(s) and address(es) of all addtional assignees on page 2 of this form or on a separate attached
sheet ofpaper.
'Ihis record title assignment is Mr: (Check one)
Interest conveyed: (Check one or both, as appropriate) Record Title,
2. this assignment conveys the following interest:
FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE
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.
U Assignment approved for above described lands;
Assignment approved effective
(Continued on page 2)
FA
Oil and Gas lease, or E Geothemal. Lease
n Assignment approved for attached land description
Bureau ofLand Management (BLM) .O E o. f 1 L%t' i-hl(i CUi n1:: r) V'; Go 1(tle)
r
1 L =PI ()C C_l;I filANA.t ECOFC`I
Assignment approved for and description indicated on reverse
of this form
00722
Oveniding Royalty, payment out of production or other similar interests
or payments
(Date)
Part A (Continued): ADDITIONAL SPACE for ..ames and addresses of additional assignees in Item No.1, if r,,,.ded, or for Land Description in Item No. 2, if needed.
Executed this
Assignor
Salt Lake City
Name of Assignor as shown on
1257 Third Avenue
(City)
(Continued on page 3)
PART B CERTIFICATION AND REQUEST FOR APPROVAL
The Assignor certifies as owner if an interest in the above designated Iease 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 ofNPR -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
herein.
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.
day of
trent lease Kearns Tribune Corporation
JW Gallivan, President
(Assignor's Address)
UT 84103
(State) (Zip Code)
20 ►i Executed this
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. p.- p I,q
to be .f:uc«iIc1 cotrlparativo copy
Li!, r ioial records oft file
1.1'1 9: 00
'El VED
nntr U y t XI
I,t 1,,. �'V S f v UM(N4!
1.11 =�lN �Mf.: i fon fifiAfkdltNnta:mn
day of
Assignee's
00723
20L
(Form 3000 -3, page 2)
EXHIBIT "A"
Attached hereto and made part of Assignment of Overriding Royaltylaterest in a Lease for Oil and Gas:
Name
Keams Tribune Corporation
to:
Name
Alpine King Ina.
Ivers Oil Company LLC
Kearns Campbell Investments
Dated October 31 2011
Address
1257 Third Avenue SLC TJT 84103
111 E Lindon Road Ste 4 Spokane WA 99208
217 Cedar Street #236 Sandpoint ID 83864
Signed for Identification:
;111.1' fl,1
fji (.0,11
Percent
1 1.1 11111111
Percent
6.99999999993 (63%)
2.88888888886 (26%)
122=2221 (11%)
00724
STATE of Utah
ss
COUNTY of Salt Lake)
,CN
On the 31st day of October 2011 before me personally appeared J a 1�
Y P Y pP
who being by me duly sworn, did say that he is the President of Kearns Tribune
Corporation and that said instrument was signed in behalf of said Corporation, who duly
acknowledged to me that they executed the s. me.
My Commission expires:
August 30 2015
ti tatA}kA
NOTAR PUBLIC
Residing at Salt Lake County
i'A VY
)il j1(F;
fail i;` 1 0,I'41 i N'``EIVW
00125