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Home My WebLink About963062Land 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 agreetnents shall only be referenced herein. a Owned h Conve ed y c Retained d Reserved e Previously reserved or conveyed f Township 26 North, Range 113 West, 6th P.M, Wyoming Section 3: SW1 /4 SE1 /4 Section 10: W1/2 SWI /4 Containing 120 Acres ECEIVED 2/3/2012 at 11:48 AM RECEIVING 963062 BOOK: 780 PAGE: 730 JEANNE WAGNER :OLN COUNTY CLERK, KEMMERER, WY See Exhibit "A" See Exhibit "A" of record FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE Form 3000 -3 UNITED STATES (May 2006) DEPARTMENT OF THE INTERIOR 1 ..,.0 1' 9 -'t. 00 BU REAU OF LAND MANAGEMENT eti i R LIN 1. Assignee" Street City, State, Zip Code (Continued on page 2) 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.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) See Exhibit "A" 2. This assignment conveys the following interest: .Assignment approved effective Bureau of Land Management (BLM) Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT la. Assignor See Exhibit "A" Lease Serial No. WYE- 07798C Lease Effective Date (Anniversary Date) New Serial No. *i f more than one assignee, check here 171 l and list the name(s) and address(es) of all addtional assignees on page 2 of this form or on a separate attached sheet of paper. This record title assignment is for: (Check one) 171 J Oil and Cias Lease, or n� Geothennal !..ease interest conveyed: (Check 017E or both, as appropr•iale) C Record Title, 71 Overriding Royalty, payment out of production or other similar interests or payments 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. n Assignment approved for above described lands RI I�r 1 i (1 i AN'1ANAti EMENiT• Assignment approved for attached land description C Assignment approved for land description indicated on reverse of this form 00730 FORM APPROVED OMB NO. 1004 -0034 Expires: April 30, 2009 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. 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 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). 1 certify that the statem2nts made herein by me are true, complete, and correct to the best of my knowledge an Executed this t• Name of Assignor as shown on Assignor 1257 Third Avenue Salt Lake City JW Gallivan, President (City) Title 18 U.S.C. Sec.1001 makes it a crime for any person knowingly and willfully to m fraudulent statements or representations as to any matter within its jurisdiction. (Continued on page 3) PART B CERTIFICATION AND REQUEST FOR APPROVAL day of rrent lease Kearns Tribune Corporation (Signature) C20 \A (Assignor's Address) UT 84103 (State) (Zip Code) to e 0 Executed this Cam' t �t V(, NCM e to any Department or agency of the United States any false, fictitious, or T6 ED li t 0 i; t G py the o cial records o rti liar A11 F111ft MAt'°t_iiflCAtT day of 0 0 belief and are made in good faith. 00731 arns Ca pbe11 ,nvestment (Form 3000 -3, page 2) EXHIBIT "A" Attached hereto and made part of As*ament of Overriding Royalty Interest in a Lease far Oil and Gas: Nam Kearns Tribune Cotporation to: Name Address Percent Alpine King Inc. 1?57 Third Avenue SLC UT 84103 6.99999999993 (63%) Ivers Oil Company LLC 111 Ei inrion Road Ste 4 Spokane WA 99208 2.88888888886 (26%) Kearns Campbell Investments 217 Cedar Street AM ID 83854 122222222221 (11%) Dated October 31 2011 Signed for Mediu' cation: Jr I'm,' fid o r te.1 e,r:it ERTL r r) fru copy U12 0 recorc;[.., on the BUFIEAU Or J M Percent 11.111111111 0973 1.10 C.7). STATE of Utah ss COUNTY of Salt Lake) On the 31st day of October 2011 before me personally appeared JW 1'ari {r lfl4 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 same. My Commission expires: August 30 2015 „s WMAAA f NOTARY PUBLIC Residing at Salt Lake County Notary PubHC -stratede. Commission#812133 My Commission Expires August 30,2010 1016 N. 3500 W. Layton, UT 84041 i: ..z.4`f;r rr j in b8 tit and I;''J'a copy 0 LiL: eii,...lat LJiR_' 0:t iile 00 733 +Erg 9: 00