HomeMy WebLinkAbout963395Form 3000 -3a
(January 1996)
UNITED STA I bS
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
TRANSFER OF OPERATING RIGHTS (SUBLEASE) 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)
Type or print plainly in ink and sign in ink
PART A: TRANSFER
1. Transferee (Sublessee)* Wamsutter Gas Partners LLC
Street 410 17th Street, Suite 1150
City, State, ZIP Code Denver, Colorado 80202
*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 a
separate attached sheet of paper.
This transfer is for: (Check one) D Oil and Gas Lease, or Geothermal Lease
Interest conveyed: (Check one or both, as appropriate)
2. This transfer (sublease) conveys the following interest:
b
Conveyed
c
Percent of Interest
Owned
Retained
d
Reserved
e
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.
a
SEE EXHIBIT "A" ATTACHED HERETO AND MADE
A PART HEREOF FOR DESCRIPTIONS AND INTERESTS
RECEIVED 2/27/2012 at 3:25 PM
RECEIVING 963395
BOOK: 781 PAGE: 788
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
THE UNITED STATES OF AMERICA
00788
1 i
FORM APPROVED
OMB NO. 1004 -0034
Expires: September 30, 1998
Lease Serial No.
WYW- 128179
Operating Rights (sublease) Overriding Royalty, payment out of production or other
similar interests or payments
Percent of
Overriding Royalty
or Similar Interests
Previously
reserved
or conveyed
III I11111111II RC
RECORDED 10/ 7/2011 AT 9 00 AM REC 1613189 BK# 1190 PG# 1686
Steven Dale Davis, CLERK of SWEETWATER COUNTY, WY Page 1 of 4
1 1 1 1 1
FOR BLM USE ONLY DO NOT WRITE BELOW THIS LINE
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. p
Transfer approved effective
/S/ Julie L. Weaver Ghiet, Watch 0t Fluid Cu atefad;<, Added caUo
By
(Authorized Officer) (Title) (Date)
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.
Executed this (la' day of March 2011, Executed this
but effective October 1, 2010.
Name of Transferor. .,Donald B. Anderson Ltd.
I
/j
Donald B. Anderson, General Partner
Transferor
or
Transferee
or
Transferor (Additional) Attorney in fact
Atterney- in -faet
1225 17th Street, Suite 1750 Transferee
(Transferor's Address)
or
BURDEN HOURS STATEMENT
RECORDED 10/17/2011 AT 9 00 AM REC 1613189 BK# 1190 PG# RC 1687
Steven Dale Davis, CLERK of SWEETWATER COUNTY, WY Page 2 of 4
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. The transferor certifies as owner of an interest in the above designated lease that he /she hereby transfers to the above transferee(s) the rights specified above.
2. Transferee certifies as follows:(a) Transferee 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 transfer of NPR -A leases, transferee is a citizen, national, or resident alien of the United States or
associations of such citizens, nationals, resident aliens or private, 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 are located;(c) Transferee'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; and (d) All parties holding an interest in the transfer are otherwise in compliance with the regulations (43 CFR Group
3100 or 3200) and the authorizing Acts; (e) Transferee 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) Transferee is not in violation of sec. 41 of the Mineral Leasing Act.
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 operations on the leasehold in accordance with the terms and conditions of
the lease, to condition all wells for proper abandonment, to restore the leased lands upon completion of any operations as described in the lease, and to furnish and maintain
such bond as may be required by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206.
For geothermal transfers, 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 transfer 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
00789
(Signature)
Wamsutter Gas Partners LLC
By: Morse Energy Partners II LLC, Managing Member
By: Morse Energy M/ ement II LLC, Managing Member
Denver Colorado 80202 Attorney -in -fact
(City) (State) (Zip Code) (Signature)
2011
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 reviewing 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
Management, Bureau Clearance Officer (DW -110), Denver Federal Center, Building 40, P.O. Box 25047, Denver, CO 80225 -0047 and the Office of Management and
Budget, Paperwork Reduction Project (1004- 0034), Washington, D.C. 20503.
Title 18 U.S.0 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.
STATE OF COLORADO
)ss.
COUNTY OF DENVER
On this 9 day of March 2011, before me, a Notary Public in and for said
State and County, personally appeared Donald B. Anderson, known to me to be the General
Partner of Donald B. Anderson Ltd., a New Mexico General Partnership, that executed the
above instrument or the person who executed the instrument on behalf of said partnership
and acknowledged to me that such partnership executed the same.
WITNESS my hand and official seal.
My commission expires:
/3 69)"/ v /d
STATE OF COLORADO
ss:
COUNTY OF 1 JQ,,y\V.
My Commission Expires:
ACKNOWLEDGMENTS
Notary Public
1
u0790
The foregoing instrument was acknowledged before me this ,„/C-V" day of
2011, by ,i1 k A .S 0-15 as Manager of Wamsutter Gas Partners LLC on behalf of
said limited liability company.
111111111111111111111111111111111111111111111111111111111
Not ry Public
RECORDED 10/17/2011 AT 9 00 AM REC 1613189 BK# 1190 PG# RC 1688
Steven Dale Davis, CLERK of SWEETWATER COUNTY, WY Page 3 of 4
WYW- 128179
My Commission Expires 0610412
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