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HomeMy WebLinkAbout963063Land 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 Conveyed c Retained d Reserved e Previously reserved or conveyed f Township 26 North, Range 113 West, 6th P.M., Wyoming Section 3: Lots 8, 9, E1 /2 SE1 /4 Section 10: N1 /2 NE1 /4, E1 /2 SW1 /4 Containing 320 Acres RECEIVED 2/3/2012 at 11:50 AM RECEIVING 963063 BOOK: 780 PAGE: 734 JEANNE WAGNER .INCOLN 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 (May 2006) 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, n Assignment approved for above described lands; Assignment approved effective B L. Assignee* Sheet City,. State, Zip Code *If than one assignee, check here 17 I 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) 1 I Oil and Gas Lease, or ❑1...1d. Geothermal Lease Interest conveyed: (Check one or both, as appropriate) C Record Tide, Overriding Royalty, payment out of production or other similar interests or payments (Continued on page 2) UNITED STATES DEPARTMENT OF THE INTERIOR 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" Bureau of Land Manageinent (BLM) Type or print plainly in ink and sign in ink PART A: ASSIGNMENT to be CERTIFIED true and comparativ Ia. Assignor See Exhibit "A" 1 Assignment approved for attached land description I1 EAU OF LPNt MANAGEMENT FORM APPROVED OMB NO. 1004 -0034 Expires: April 30, 2009 Lease Serial No. WYE 07798D Lease Effective Date (Anniversary Date) New Serial No. Assignment approved for land description indicated on reverse of this form 2 00734 (Date) 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. PART B CERTIFICATION AND REQUEST FOR APPROVAL 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). 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. 20 I Executed this N day of C' Executed this lJ Name of Assigno Assignor 1257 Third Avenue Salt Lake City s shown o (City) day of rrent lease Kearns Tribune Corporation (Signature) JW Gallivan, President (Assignor's Address) UT 84103 (State) (Zip Code) Assignee's 9' OD E O 20 fir/ /r At fi L/ i K arns Ca pb investment Title 18 U.S.C. Sec.1001 makes it a crime for any person knowingly and willfully to ake to any De ailment or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. ERT F EL) li Cc fl.Jdid[vt the off' al records on file (Continued on page 3) BUREAU OF 1 AND it iANAr rMFMT 00735 (Form 3000 -3, page 2) EXEUNT "A” Attached hereto and made part of Assignment of Overriding Royalty Interest in &Lease for OR and (3as: Nam Kearns Tribune Corporation to: Name Address percent Alpine King Inc. 1257 Third Avenue SLC UT 84103 6.99999999993 (63%) Ivera Oil Company LLC 111 E Linden Road Ste 4 Spokane WA 99208 2.88888888886 (26%) Kearns Campbell Investments 217 Cedar Streetiag6 Sandpoint ID =64 122229222221 (1 J%) Dated October 31 2011 Signed for Identification: ERTIF1 ED iCS be true end comparative copy of tic Odic" I records on tile „-;7 crr) ,AU OF LAND kNAGEMENT Percent 11_111111111 0”,36 STATE of Utah ss COUNTY of Salt Lake) My Commission expires: August 30 2015 NOTARY UBLIC Residing at Salt Lake County CERTIFIED to ti a true. a' d compa copy of the o f` iat records on filo tip/ Uf EM OF LAND NAGEMENT 2fn; NOV 00737 On the 31st day of October 2011 before me personally appeared `l 'i:v Vst 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. 00