HomeMy WebLinkAbout969030L and Description
Percent of Interest
Percent of
Overriding Royalty
Similar Interests
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
Owned
b
Conveyed
c
Retained
d
Reserved
e
Previously
reserved
or conveyed
f
Township 26 North, Range 113 West, 6th PM, WY
Section 32: S /2NE /4, NW /4, N /2SW /4, SW /4SW /4, SE /4
Section 33: SW /4NW /4, S/2
Lincoln County, WY
RECEIVED 1/14/2013 at 3:04 PM
RECEIVING 969030
BOOK: 802 PAGE: 639
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
100%
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NAGEMEN
Form 3000 UNITED STATES
(February 2002) l t( ,i7iti DEPARTMENT OF THE INTERIOR
ii 0,1 1 n1<� '�M'tiJ BUREAU OF LAND MANAGEMENT
ASSIGNMENT OF RECORD TITLE INTEREST IN A
t
7 20 11.EA POR OIL AND GAS OR GEOTHERMAL RESOURCES
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
V t A-) Act for Acquired Lands of 1947 (30 U.S.0 351 -359)
ti5 Q M H' C Steam Act of 1970 (30 U.S.C. 1001 -1025)
C t Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
By
Assignee* Encore Operating, L. P.
Street 777 Main Street, Suite 1400
City, State, ZIP Code Fort Worth, TX 76102
*If more than one assignee, check here and list the name(s) and address(es) of all additional assignees
separate attached sheet of paper.
This record title assignment is for: (Check one) Oil and Gas Lease, or
2. This assignment conveys the following interest:
Assignment approved effective
(Continued on reverse)
N{1IY d 12007
(Authorized Officer)
Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
Geothermal Lease
LAND LAW (Tdle E) XAM¢ER
FORM APPROVED
OMB NO. 1004-0034
Expires: 0 ctober 31, 2004
Lease Serial No.
WYW 173033
Lease Effective Date
(Anniversary Date)
February 1, 2007
New Serial No.
on the reverse of this form or on a
Interest conveyed: (Check one or both, as appropriate) 0 Record Title, Overriding Royalty, payment out of production or other similar
interests or payments
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
iv quitable title to this lease.
Assignment approved for above described lands;
Assignment approved for attached land description
QRIQIINA.L
00639
Assignment approved for land description indicated on reverse
of this form.
T
JUL 2 7 2007
Part A ADDITIONAL SPACE Names and addresses of a ssignees in Item No. needed, or for Land Dc Item No. 2, if
needed.
Executed this 14th day of February 20 07
Name of Assign shown on current lease
1
(City)
(Form 3000 -3 (1/99) (page 2)
Rhame
PART B CERTIFICATION AND REQUEST FOR APPROVAL
(Signature)
P. 0. Box 156
(Assignor's Address)
Kirk D. Martinez
ND 58651
(State) (Zip Code)
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BUREAU OF LAND y't,ttorrr.1�,..
i s+i. /w LAND I tilll 'Li 1.,1
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CHEYENNE, WYOMING
TIFIED
to be a a an Comparat ve copy
of %e offici!_ records on file
OF LAND
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 of NPR -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.
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.
Executed this day of f 20 c .7
Assignor Assignee
or (SiSe) or (Signature)
Attomey -in -fact Attorney -in -fact c' ✓r'
(Signature)
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 (1004- 0034), Bureau Clearance Officer, (WO -630), Mail Stop 401 LS, 1849 C Street, N.W., Washington, D.C. 20240.
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.
1. Assignor /Assignee(s) must complete Parts Al and A2 and Part B. All parties to
assignment must sign as follows: The assignor(s) must manually sign 3 original
copies and the assignee(s) must manually sign at least 1 of the 3 original copies.
File three (3) completed copies of this form in the proper BLM office for each
assignment of record title. For a transfer of overriding royalty interest, payment
out of production or other similar interest or payment, file one (1) manually signed
copy of this form. The required filing fee (nonrefundable) must accompany the
assignment. File assignment within ninety (90) days after date of execution of
assignor.
2. Separate form must be used for each lease being affected by this assignment and
for each type of interest conveyed.
3. In Item No. 2 of Part A, describe lands affected (See 43 CFR 3106, 3135, or
3241). For column b, c, d, and e, enter the interest expressed as a percentage
of total interest in the lease; e.g., if assignor assigns one quarter of a 20% in-
terest, enter 20% in column b, 5% in column c, and 15% in column d.
4. If assignment is to more than one assignee, enter each assignee's name across
PAPERWORK REDUCTION ACT STATEMENT
1. This information is being collected pursuant to the law.
2. This information will be used to create and maintain a record of oil and
gas/geothermal lease activity.
3. Response to this request is required to obtain benefit.
BLM would like you to know that you do not have to respond to this or any other
Federal agency sponsored information collection unless it displays a currently
valid OMB control number.
The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be
furnished the following information in connection with information required by this
oil and gas /geothermal lease record title assignment application.
AUTHORITY: 30 U.S.C. 181 et seq.; 30 U.S.C. 1001 -1025; 42 U.S.C. 6508
PRINCIPAL PURPOSE: The information is to be used to process record title as-
signments for oil and gas /geothermal resources leases.
(Form 3000 -3 (1/99) (page 3)
NOTICE
PART C- GENERAL INSTRUCTIONS
0 0641
5. If any payment out of production or similar interests, arrangements or payments
have previously been created out of the interest being assigned, or if any such
payments or interests are reserved under this assignment, include a statement giving
full details as to amount, method of payment, and other pertinent terms as provided
under 43 CFR 3106, 3135, or 3241.
6. The lease account must be in good standing before this assignment can be ap-
proved as provided under 43 CFR 3106 and 3241.
7. Assignment, if approved, takes effect on the first day of the month following the
date of filing in the proper BLM office. If a bond is necessary, it must be fur-
nished prior to approval of the assignment.
8. Approval of assignment of record title to 100% of a portion of the leased lands
creates separate leases of the retained and the assigned portions, but does not change
the terms and conditions of the lease anniversary date for purposes of payment
of annual rental.
9. Overriding royalty, payment out of production or other similar types of transfers
must be filed with BLM, but will be accepted for record purposes only. No offi-
cial approval will be given.
ROUTINE USES:
(1) The adjudication of the assignee's rights to the land or resources.
(2) Documantation for public information in support of notations made on land status,
records for the management, disposal, and use of public lands and resources.
(3) Transfer to appropriate Federal agencies when concurrence is required prior to
granting a right in public lands or resources.
(4)(5) Information from the record and/or the record will be transferred to appropri-
ate Federal, State, local or foreign agencies, when relevant to civil, criminal or regula-
tory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION If all requested informa-
tion is not provided, the assignment may not be approved. See regulations at
43 CFR Groups 3100 and 3200.
to be al
of t
R71FIE
records n fil �y
AU OF L' ND /i NAGEMENT
THE STATE OF NORTH DAKOTA
COUNTY OF BOWMAN
ACKNOWLEDGEMENT
Personally appeared before me, the undersigned authority in and for the said
county and state, on this 7 day of February, 2007, within my jurisdiction, the
within named, Kirk D. Martinez, who acknowledged that he executed the above and
foregoing instrument on the day and year mentioned, as his free and voluntary act and
deed and for the purposes therein stated.
GIVEN UNDER MY HAND AND OFFICIAL SEAL, this 7,/ day of
February, 2007.
Notary ublic in and for
The S to of
My Commission Expires:
Printed Name:
ALFRED F. TAMAYO
NOTARY PUBLIC, STATE OF NORTH DAKOTA
MY COMMISSION EXPIRES FEB. 25, 2010
0 0 64
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OF LAND NANA
L.17 APR 20 P14 1: 30
CHEYENNE. WYOMING
RTIFIED
to be a e an cd' omparafive copy
of a officiy ecords on file
2013,
ND O
AGEMENT