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